ABSTRACT
The investigators review the electrocardiographic manifestations of hiatal hernia and describe the case of an 86-year-old male who presented with a large distended hiatal hernia causing electrocardiographic findings of new onset ST segment elevation of the inferior leads without reciprocal changes. After decompression, the patient's electrocardiogram demonstrated resolution of the ST segment elevation.
ABSTRACT
Pulmonary emphysema is a disease characterized by alveolar cellular loss and inflammation. Recently, excessive apoptosis of structural alveolar cells has emerged as a major mechanism in the development of emphysema. Here, we investigated the proapoptotic and monocyte chemoattractant cytokine endothelial monocyte-activating protein 2 (EMAPII). Lung-specific overexpression of EMAPII in mice caused simplification of alveolar structures, apoptosis, and macrophage accumulation, compared with that in control transgenic mice. Additionally, in a mouse model of cigarette smoke-induced (CS-induced) emphysema, EMAPII levels were significantly increased in murine lungs. This upregulation was necessary for emphysema development, as neutralizing antibodies to EMAPII resulted in reduced alveolar cell apoptosis, inflammation, and emphysema-associated structural changes in alveoli and small airways and improved lung function. The mechanism of EMAPII upregulation involved an apoptosis-dependent feed-forward loop, since caspase-3 instillation in the lung markedly increased EMAPII expression, while caspase inhibition decreased its production, even in transgenic EMAPII mice. These findings may have clinical significance, as both current smokers and ex-smoker chronic obstructive pulmonary disease (COPD) patients had increased levels of secreted EMAPII in the bronchoalveolar lavage fluid compared with that of nonsmokers. In conclusion, we suggest that EMAPII perpetuates the mechanism of CS-induced lung emphysema in mice and, given its secretory nature, is a suitable target for neutralization antibody therapy.
Subject(s)
Cytokines/physiology , Neoplasm Proteins/physiology , Pulmonary Emphysema/genetics , RNA-Binding Proteins/physiology , Tobacco Smoke Pollution/adverse effects , Adult , Animals , Antibodies, Neutralizing/therapeutic use , Apoptosis , Atmosphere Exposure Chambers , Bronchioles/drug effects , Bronchioles/pathology , Bronchoalveolar Lavage Fluid/chemistry , Caspase 3/toxicity , Caspase Inhibitors , Cytokines/therapeutic use , Female , Gene Expression Regulation/drug effects , Gene Expression Regulation/genetics , Humans , Immunization, Passive , Macrophages/pathology , Male , Mice , Mice, Inbred Strains , Mice, Transgenic , Middle Aged , Neoplasm Proteins/therapeutic use , Pulmonary Alveoli/metabolism , Pulmonary Alveoli/pathology , Pulmonary Emphysema/etiology , Pulmonary Emphysema/metabolism , RNA-Binding Proteins/therapeutic use , Rats , Recombinant Fusion Proteins/administration & dosage , Recombinant Fusion Proteins/physiology , Recombinant Fusion Proteins/therapeutic use , Smoking/adverse effects , Smoking/metabolism , Young AdultABSTRACT
BACKGROUND: Fragmented QRS complexes (fQRS) on a 12-lead ECG are a marker of myocardial scar in patients with coronary artery disease. Cardiac sarcoidosis is also associated with myocardial granuloma formation and scarring. We evaluated the significance of fQRS on a 12-lead ECG compared to Gadolinium-delayed enhancement images (GDE) in cardiac magnetic resonance imaging (CMR). METHOD AND RESULTS: The ECGs of patients (n = 17, mean age: 52 +/- 11 years, male: 53%) with established diagnosis of sarcoidosis who underwent a CMR for evaluation of cardiac involvement were studied. ECG abnormalities included bundle branch block, Q wave, and fQRS. fQRS, Q wave, and bundle branch block were present in 9 (53%), 1 (6%), and 4 (24%) patients, respectively. The sensitivity and specificity of fQRS for detecting abnormal GDE were 100% and 80%, respectively. Sensitivity and specificity of Q waves were 11% and 100%, respectively. CONCLUSIONS: fQRS on a 12-lead ECG in patients with suspected cardiac sarcoidosis are associated with cardiac involvement as detected by GDE on CMR.
