Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death.

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.

Impaired systolic dysfunction of left ventricular longitudinal fibers: a sign of early hypertensive cardiomyopathy.

BACKGROUND: Atrioventricular plane displacement (AVPD) study by M-mode echocardiography can supply useful clinical information about left ventricular (LV) long-axis function. HYPOTHESIS: We assessed the hypothesis that AVPD estimation could be used to detect early hypertensive cardiomyopathy. METHODS: The study population included 81 hypertensive patients with normal LV ejection fraction and fractional shortening, and 50 age- and gender-matched healthy controls. By utilizing M-mode and apical views, the following parameters were estimated: early mitral flow peak velocity (E) and deceleration time (DT), peak velocity of late mitral flow (A), A/E ratio, isovolumic relaxation time (IVRT), total AVPD, AVPD motion during atrial systole (At), systolic AVPD (total AVPD-At), and At/total AVPD ratio. RESULTS: Of 81 hypertensive patients, 16 (19.7%) had a normal (Group 1) and 65 (80.3%) an impaired LV relaxation filling pattern (Group 2). Mean total AVPD-At was significantly lower in Group 2 than in Group 1 (7.1 +/- 2 vs. 10.3 +/- 3 mm, p<0.001) and in Group 1 compared with healthy subjects (10.3 +/- 3 vs. 13.1 +/- 1 mm, p<0.001). Mean At and At/total AVPD were significantly higher in Group 2 than in Group 1 (46.9 +/- 8.6 vs. 37.7 +/- 8.7%, p<0.001), but not in Group 1 compared with healthy subjects (37.7 +/- 8.7 vs. 36 +/- 6%, p>0.05). CONCLUSIONS: Hypertensive patients without overt systolic dysfunction demonstrate LV long-axis systolic dysfunction, while long-axis diastolic dysfunction always coexists with abnormal diastolic filling patterns. This suggests that long-axis systolic dysfunction precedes diastolic dysfunction at the same axis in hypertensive patients.

Kugel's artery: an anatomical and angiographic study using a new technique.

In this study, we tried to resolve the confusion in the literature regarding the existence and course of Kugel's artery. With the aid of a new technique, we studied 100 human hearts ex vivo by radiography and by direct observation through dissection, to demonstrate anatomical and postmortem angiographic findings of Kugel's artery. Kugel's artery was found in only 6 hearts out of 100 (6%). It originated from the proximal left circumflex artery and ended in the right coronary artery in 2 cases; from the right coronary artery and ended in the same artery in 2 cases; from the left circumflex artery and ended in the same artery in 1 case; and from the right coronary artery through the sinus node artery, ending in the left circumflex artery, in 1 case. In all 100 hearts, an anastomotic network of small atrial branches was found in the same area (lower portion of the interatrial septum), connecting the large vessels indirectly. Branches of the sinus node artery in all hearts, and of the atrioventricular node artery in 66 hearts, participated in this network. Our procedure showed the detailed course of Kugel's artery and its course independent from the atrioventricular node artery and from the anastomotic network. In conclusion, in all cases an anastomotic network of small atrial branches courses through the lower interatrial septum and connects indirectly the proximal and distal ends of the larger coronary arteries. Kugel's artery provides an additional direct arterial anastomosis in the same area in 6% of the hearts.

Histologic findings in left ventricle papillary muscle arteries from human hearts.

We describe original histologic findings of left ventricle papillary muscle (LVPM) arteries in people under 30 years of age. We examined 666 samples taken from the tip, mid-portion and base of papillary muscles in 56 males and 55 females, as well as several samples from the rest of the left ventricle. The number of smooth muscle cells (SMC) in the tunica media of the LVPM arteries led us to divide the samples examined into three groups: (i) group 1, 355 samples (53%) with a normal number of SMC and a normal lumen (the number of group 1 samples increased from the tip (21%) to the base (47%)); (ii) group 2, 252 samples (38%) with a mild to moderately increased number of SMC (the number of these samples decreased from the tip (44%) to the base (22%)); and (iii) group 3, 59 samples (9%) with abundant SMC that were more than twofold greater in size and number of normal arteries, in contrast with the other two groups. The shape of the SMC in group 3 samples was round and the extremely narrow, centrally located lumen of these SMCE had a round or oval shape. These changes were restricted only to papillary muscle arteries and the number of group 3 samples decreased from the tip (63%) to the mid-portion (37%). No inflammatory reaction or chronic ischemic changes were found in the LVPM arteries and surrounding area. The SMC changes in groups 2 and 3 were found in subjects aged more than 2 months. These findings will provide anatomists, cardiologists, pathologists and physiologists with valuable knowledge and will trigger further investigation into the etiology of the structural changes observed and their evolution with age.