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Coronary Microcirculatory Dysfunction in Human Cardiomyopathies: A Pathologic and Pathophysiologic Review. Cardiol Rev 2018; 25:165-178. [PMID: 28574936 DOI: 10.1097/crd.0000000000000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death. Due to the heterogeneity of cardiomyopathic patterns and symptoms, their diagnosis and therapies are great challenges. Despite extensive research, the relation between the structural and functional abnormalities of the myocardium and the coronary circulation are still not well understood in the various forms of cardiomyopathy. The main pathological characteristics of cardiomyopathies and the coronary microcirculation develop in a progressive manner due to (1) genetic-immunologic-systemic factors; (2) comorbidities with endothelial, myogenic, metabolic, and inflammatory changes; (3) aging-induced arteriosclerosis; and (4) myocardial fibrosis. The aim of this review is to summarize the most important common pathological features and/or adaptations of the coronary microcirculation in various types of cardiomyopathies and to integrate the present understanding of the underlying pathophysiological mechanisms responsible for the development of various types of cardiomyopathies. Although microvascular dysfunction is present and contributes to cardiac dysfunction and the potential outcome of disease, the current therapeutic approaches are not specific for the given types of cardiomyopathy.
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Bustinduy AL, Luzinda K, Mpoya S, Gothard P, Stone N, Wright S, Stothard JR. Endomyocardial fibrosis (EMF) in a Ugandan child with advanced hepatosplenic schistosomiasis: coincidence or connection? Am J Trop Med Hyg 2014; 91:798-800. [PMID: 25002295 DOI: 10.4269/ajtmh.14-0156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An association between late-stage hepatosplenic schistosomiasis and endomyocardial fibrosis (EMF) has been suggested but not proven. We present the case of a 12-year-old Ugandan boy with striking comorbidities, including advanced periportal fibrosis caused by Schistosoma mansoni infection and right ventricular EMF, and discuss the possible correlation between both diseases.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - Kenneth Luzinda
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - Simon Mpoya
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - Philip Gothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - Neil Stone
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - Stephen Wright
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Pediatrics, Guy's and St. Thomas's National Health Service (NHS) Trust, London, United Kingdom; Department of Internal Medicine, Mulago Hospital, Kampala, Uganda; Department of Radiology, Mulago Hospital, Kampala, Uganda; Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom; Department of Infection, Guy's and St. Thomas's NHS Trust, London, United Kingdom
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