DOI: https://doi.org/10.22141/2224-0586.16.1.2020.196924

Myocardial injury

L.M. Yakovleva, L.M. Yakovleva

Abstract


The review deals with the clinical difference between myocardial infarction types according to the Fourth Universal Definition of Myocardial Infarction. The troponin holds a central place as the marker of cardiac muscle injury in modern diag­nostics of myocardial infarction, in particular, it is important to control the troponin level in dynamic. The non-ischemic myocardial injury is described as a condition of elevated troponin level in the absence of clinical data supporting myocardial ischemia. The ischemic injury pathophysiology is represented as the dynamic process. Short-term changes, including cardiomyocyte calcium overload, are described as “ischemic cascade”. The mechanisms of cardiac adaptation to the conditions of ischemia, myocardial hibernation and stunning, are described along with the clinical situations in which those conditions are likely to develop. Possible causes of non-ischemic cardiac muscle injury are provided, in particular, heart failure, inflammatory diseases, cardiomyopathies, arrhythmias and repeated defibrillations, invasive procedures and mechanic cardiac trauma, myocardial infiltration, pulmonary embolism, chronic renal diseases, sepsis, the toxicity of some medicaments, including chemotherapy used in oncologic practice. In heart failure, the possible troponin lea­kage from injured cardiomyocytes is shown at the absence of cell necrosis, after excessive wall stress caused by pressure and/or volume overload. In sepsis-induced cardiomyopathy, the inflammatory cytokines are described to affect myocardium along with the mechanism leading to inducible nitric oxide synthase activation, mitochondrial function disturbance, cellular energy deficient. The mechanism of catecholamine-induced myocardial dysfunction is described by the example of Takotsubo cardiomyopathy, with the specific pattern of reduced contractility that does not correspond to the coronary flow distribution.

Keywords


myocardial infarction; non-ischemic myocardial injury; troponin; sepsis-induced cardiomyopathy; Takotsubo cardiomyopathy; heart failure

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