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Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. The aim of this systematic review is to better understand the various aspects of the cardiovascular complications of COVID-19 by pooling data from a large number of autopsy studies. We searched the online databases Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science for concepts of autopsy or histopathology combined with COVID-19, published between database inception and February 2021. We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory. Articles were considered eligible for inclusion if they reported human postmortem cardiovascular findings among individuals with a confirmed SARS coronavirus type 2 (CoV-2) infection. Confirmed COVID-19 patients with post-mortem cardiovascular findings. None. Studies were individually assessed for risk of selection, detection, and reporting biases. The median prevalence of different autopsy findings with associated interquartile ranges (IQRs). This review cohort contained 50 studies including 548 hearts. The median age of the deceased was 69 years. The most prevalent acute cardiovascular findings were myocardial necrosis (median: 100.0%; IQR, 20%–100%; number of studies = 9; number of patients = 64) and myocardial oedema (median: 55.5%; IQR, 19.5%–92.5%; number of studies = 4; number of patients = 46). The median reported prevalence of extensive, focal active, and multifocal myocarditis were all 0.0%. The most prevalent chronic changes were myocyte hypertrophy (median: 69.0%; IQR, 46.8%–92.1%) and fibrosis (median: 35.0%; IQR, 35.0%–90.5%). SARS-CoV-2 was detected in the myocardium with median prevalence of 60.8% (IQR 40.4-95.6%). Our systematic review confirmed the high prevalence of acute and chronic cardiac pathologies in COVID-19 and SARS-CoV-2 cardiac tropism, as well as the low prevalence of myocarditis in COVID-19. [ABSTRACT FROM AUTHOR]

• Electron microscopy (EM) interpretation is a lost art, even in academic centers. • There remain situations in which EM is the best or only ancillary test to ascertain a specific diagnosis. • This article reviews EM as it pertains to myocardial tissue and provides illustrative examples of the spectrum of ultrastructural cardiac pathology seen in storage/metabolic diseases, cardiomyopathies, infiltrative disorders, and cardiotoxicities. Electron microscopy (EM) was a popular diagnostic tool in the 1970s and early 80s. With the adoption of newer, less expensive techniques, such as immunohistochemistry, the role of EM in diagnostic surgical pathology has dwindled substantially. Nowadays, even in academic centers, EM interpretation is relegated to renal pathologists and the handful of (aging) pathologists with experience using the technique. As such, EM interpretation is truly arcane—understood by few and mysterious to many. Nevertheless, there remain situations in which EM is the best or only ancillary test to ascertain a specific diagnosis. Thus, there remains a critical need for the younger generation of surgical pathologists to learn EM interpretation. Recognizing this need, cardiac EM was made the theme of the Cardiovascular Evening Specialty Conference at the 2023 United States and Canadian Academy of Pathology (USCAP) annual meeting in New Orleans, Louisiana. Each of the speakers contributed their part to this article, the purpose of which is to review EM as it pertains to myocardial tissue and provide illustrative examples of the spectrum of ultrastructural cardiac pathology seen in storage/metabolic diseases, cardiomyopathies, infiltrative disorders, and cardiotoxicities. [ABSTRACT FROM AUTHOR]

• Early cardiac pathology likely caused by vasoconstriction ischemia rather than anoxia • Ischemia and anoxia potentially caused by vasoconstriction of cardiac pericyte cells • Vasoconstrictions likely caused by histamine or SARS-CoV-2 pericyte infection The clinical manifestations of COVID-19 associated cardiac complications are heterogeneous, ranging from asymptomatic to severe symptoms, including arrhythmias and cardiogenic shock. For COVID-19 patients with cardiac sequela, only a small subset of patients have myocarditis; the pathogenesis of cardiac sequela caused by SARS-CoV-2 other than microthrombi associated sequela remains to be determined. Retrospective analysis of 71 heart autopsy specimens from COVID-19 and putative COVID-19 in the NIH COVID Digital Pathology Repository. The most consistent observation was localized myocardial cell death not associated with either myocarditis or microthrombi. Red blood cells were typically absent from capillaries but, when observed, were predominately in linear clusters (stacks) of adjacent cells. Based on our retrospective analysis, we propose that localized ischemia and subsequent cell death by anoxia contributes to the cardiac pathogenesis in some COVID-19 patients. We propose two new models predicting vasoconstriction of cardiac pericyte cells induced by elevated histamine from hyper-activated mast cells or direct infection. We propose that impeded blood flow and cell death by anoxia are initial steps in the development of SARS-CoV-2 induced cardiac injury in COVID-19 patients independent of microthrombi or myocarditis. [ABSTRACT FROM AUTHOR]

• A novel semi-supervised learning method is developed for apparent flow estimation. • Combining this flow with segmentation, motion-characteristic features are extracted. • An explainable and simple cardiac pathology classification model is proposed. We propose a method to classify cardiac pathology based on a novel approach to extract image derived features to characterize the shape and motion of the heart. An original semi-supervised learning procedure, which makes efficient use of a large amount of non-segmented images and a small amount of images segmented manually by experts, is developed to generate pixel-wise apparent flow between two time points of a 2D+t cine MRI image sequence. Combining the apparent flow maps and cardiac segmentation masks, we obtain a local apparent flow corresponding to the 2D motion of myocardium and ventricular cavities. This leads to the generation of time series of the radius and thickness of myocardial segments to represent cardiac motion. These time series of motion features are reliable and explainable characteristics of pathological cardiac motion. Furthermore, they are combined with shape-related features to classify cardiac pathologies. Using only nine feature values as input, we propose an explainable, simple and flexible model for pathology classification. On ACDC training set and testing set, the model achieves 95% and 94% respectively as classification accuracy. Its performance is hence comparable to that of the state-of-the-art. Comparison with various other models is performed to outline some advantages of our model. [ABSTRACT FROM AUTHOR]

Patients with cardiac pathology that require permanent antithrombotic therapy involve a higher bleeding risk, even in minor traumas, leading to severe consequences. Ultrasound imaging represents a quick and accessible investigation, in order to acquire valuable information, diagnosis and to monitor. The aim is to evaluate the ultrasound aspects in a patient with cardiac pathology, who experienced an apparently minor trauma, but with severe hepatic impact. It is presented the case of an elderly patient, diagnosed with multiple cardiac pathology: arrhythmia (atrial fibrillation, ventricular extrasystoles), hypertension, moderate heart failure, with permanent antithrombotic medication and also other associated pathologic conditions, such as: osteoporosis and spondylosis, who experienced a minor trauma (falling in the same plane), with right thoraco-abdominal impact. Post-traumatic, clinical and imagistic investigations (ultrasound and X-ray) showed costal fractures favored by osteoporosis, as well as contusions and a large hepatic hematoma, which required medical-surgical supervision. During this process, ultrasound investigation played an important role. Emergency ultrasound allowed rapid and complex diagnosis of the lesions in the cardiac patient with minor trauma. Severe lesions were found: a large, hypoecogen intrapanchimal hepatic hematoma, along with other cardiac disturbances (signs of heart failure, suprahepatic veins dilatation, cardiac cavities modifications). Differential diagnosis of the hepatic focal lesion was required [1,2]. Against the background of chronic heart disease and anticoagulants, the presence of large hepatic hematoma required ultrasound monitoring for the assessment of bleeding and hematoma aspect, together with control of medication, regarding anticoagulants and hemostatics [3]. Ultrasound investigation is important in the rapid diagnosis and assessment of post-traumatic injury, such as large hepatic hematoma, in patients with risk factors such as arrhythmic and hypertensive heart disease, antithrombotic chronic therapy, osteoporosis and rib fractures. Complex abdominal, cardiac, thoracic and vascular, non-invasive, risk-free ultrasonography allows the diagnosis of severe lesions, especially hematomas and hemorrhagic acumulations. Post-traumatic injuries, even after minor trauma, require ultrasound investigation, useful in cardiac patients with arrhythmias, hypertension and heart failure, involving the adjustment and control of therapy. [ABSTRACT FROM AUTHOR]

Aging is a complex and progressive process that involves physiological and metabolic deterioration in every organ and system. Cardiovascular diseases are one of the most common causes of mortality and morbidity among elderly subjects worldwide. Most age-related cardiovascular disorders can be influenced by modifiable behaviours such as a healthy diet rich in fruit and vegetables, avoidance of smoking, increased physical activity and reduced stress. The role of diet in prevention of various disorders is a well-established factor, which has an even more important role in the geriatric population. Melatonin, an indoleamine with multiple actions including antioxidant properties, has been identified in a very large number of plant species, including edible plant products and medical herbs. Among products where melatonin has been identified include wine, olive oil, tomato, beer, and others. Interestingly, consumed melatonin in plant foods or melatonin supplementation may promote health benefits by virtue of its multiple properties and it may counteract pathological conditions also related to cardiovascular disorders, carcinogenesis, neurological diseases and aging. In the present review, we summarized melatonin effects against age-related cardiac alterations and abnormalities with a special focus on heart ischemia/reperfusion (IR) injury and myocardial infarction. [ABSTRACT FROM AUTHOR]

We present a case of sudden cardiac death (SCD) due to accelerated atheroma in a young man. Histological specimens revealed chronic myocardial ischaemia with severe calcification. The causes of myocardial calcification are reviewed and we summarise the key learning points relating to cocaine use and heart disease. Trainees should appreciate that in cases of accelerated coronary atheroma there may be multiple risk factors involved and that family history of myocardial ischaemia is often a key contributor. [ABSTRACT FROM AUTHOR]

This is a report on a 2-day joint meeting between the British Society of Toxicological Pathology (BSTP) and the Safety Pharmacology Society (SPS) held in the UK in November 2013. Drug induced adverse effects on the cardiovascular system are associated with the attrition of more marketed and candidate drugs than any other safety issue. The objectives of this meeting were to foster inter-disciplinary approaches to address cardiovascular risk assessment, improve understanding of the respective disciplines, and increase awareness of new technologies. These aims were achieved. This well attended meeting covered both ‘purely functional’ cardiovascular adverse effects of drugs (e.g., electrophysiological and haemodynamic changes) as well as adverse effects encompassing both functional and pathological changes. Most of the presentations focused on nonclinical safety data, with information on translation to human where known. To reflect the content of the presentations we have cited key references and review articles. [ABSTRACT FROM AUTHOR]

Eosinophilic granulomatosis with polyangiitis is the rarest of the antineutrophil cytoplasmic antibody-associated vasculitides. We describe the case of a 58-year-old woman with a history of asthma found to have a left ventricular apical thrombus. Cardiac catheterization with endomyocardial biopsy was consistent with eosinophilic endomyocardial disease. The disease affects several organ systems and shares many features with more common conditions, making it a difficult diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Primary cardiac tumors are rare entities with an autopsy frequency ranging between 0.001% and 0.3%. Our objective was to review 32 years of experience from a Spanish tertiary surgical center. Method: We collected data on 73 patients with a histopathological diagnosis of a primary cardiac tumor in a retrospective analysis from 1979 to 2012. Tissue samples were obtained either at surgery or from necropsy and subsequently divided into benign and malignant groups. Results: Benign neoplasms accounted for 84.9% of cases. The average age at diagnosis was 61 years, and tumors were twice as frequent among women. It was an incidental finding in one quarter of patients. In symptomatic patients, the typical presentation was of cardioembolic stroke or of congestive symptoms. Myxoma (93.5%) was the most common diagnosis, typically affecting the left atrium (74.2%). Surgical resection was curative for 95% of these patients. Malignant tumors represented 15.1% of cases with an average age at diagnosis of 50 years. Over 90% of these patients were symptomatic at presentation with the cardinal symptom being heart failure. Undifferentiated sarcoma was the most frequent malignant tumor (36.4%). Less than 20% of patients were alive 1 year after diagnosis despite the treatment. Conclusions: In our study, primary cardiac tumors were insidious. The most common was left atrial myxoma in which surgical resection was considered curative. Undifferentiated sarcoma was the most frequent malignant tumor. Malignant neoplasms carried a worse prognosis with unsuccessful total excision and the presence of metastatic disease being markers of an adverse outcome. [Copyright &y& Elsevier]

Abstract: Immunosensors depend on the specificity of the molecular recognition towards analytes of interest provided by the antibodies. In this study, electrochemical impedance spectroscopy (EIS) was used to monitor the sensor surface assembly and recognition of two different analytes of cardiac pathology, cardiac troponin I (cTnI) and soluble lectin-like oxidized LDL receptor-1 (sLOX-1) on surfaces based on mixed self-assembled monolayers onto gold electrodes. The specificity and longer persistence of cTnI serves as a definitive biomarker in the diagnosis of acute myocardial infarction (AMI). Circulating levels of sLOX-1 serve as a marker for plaque instability or rupture before an AMI becomes apparent and facilitates early diagnosis of acute coronary syndrome (ACS). The immunosensors were highly specific, since a clinically relevant range of analyte concentrations was successfully detected in phosphate buffered saline and in serum with virtually no alteration to the slope of the calibration curve. Detection limits for cTnI and sLOX-1 immunosensors were at least 10−13 M for each analyte. Atomic force microscopy studies were carried out to study each step of fabrication to elucidate the binding characteristics and surface nanotopography of the mSAM based immunosensors. [Copyright &y& Elsevier]

Abstract: Syncope is a common but concerning event in athletic patients. As such, efforts must be made to distinguish presyncope from syncope with a critical distinction of syncope during exercise and postexercise syncope. Syncope most often occurs just after exercise and is usually benign; however, syncope during exercise may be a sign of pathologic structural or electrical cardiac issues. Solving this diagnostic puzzle mandates a detailed history and examination frequently augmented with diagnostic testing and imaging studies. Recommendations for treatment and potential restriction from activity also present challenging decisions to the health care provider. [Copyright &y& Elsevier]

Abstract: Prolonged endurance exercise in humans has been associated with an acute impairment in diastolic and systolic cardiac function and the release of cardiac troponin. In this chapter, we review recent evidence from studies using novel echocardiographic parameters and highly sensitive cardiac troponin assays. We demonstrate that the mechanics of left and right ventricular functions are acutely impaired after completion of prolonged exercise and that this reduction in function is likely multifactorial in etiology. However, we highlight that exercise-induced cardiac troponin release is not a marker of exercise-induced pathology but likely a physiologic response to exercise. Finally, we discuss the potential link between prolonged exercise and the increased incidence of cardiac pathology in veteran athletes. [Copyright &y& Elsevier]

Summary: The precise number of sudden deaths among the young person during the sports practice is badly known, but is relatively low. It strikes mainly the men and results from chronic and acute cardiac pathologies, now well identified. The big prevalency of these cardiac causes in the sudden death during the sport incites to improve the systematic cardiovascular assessment of the competition sportsmen. [Copyright &y& Elsevier]

The objective of this study was to correlate defined pathological features with clinical findings in dogs with naturally occurring congestive heart failure (CHF). Fifty-eight dogs with CHF were examined clinically and using echocardiography and electrocardiography. Detailed cardiac post-mortem examination was used to assess intra-myocardial arterial narrowing, myocardial fibrosis and atrophy and myxomatous mitral valve degeneration (MMVD). Arterial narrowing significantly correlated with fibrosis (P < 0.0001) and with fractional shortening, an indicator of systolic function (P = 0.002). The grade of fibrosis was associated with shorter survival time (P = 0.002), and the papillary muscle fibrosis score tended to correlate with proximal isovelocity surface area radius (P = 0.03). Data from this study lend support to the hypothesis that naturally occurring canine CHF is affected by several factors such as MMVD, myocardial atrophy and fibrosis, and by arteriosclerosis. Further, more extensive research will be required to establish cause-effect relationships between these cardiac lesions and the pathophysiology of CHF in dogs. [ABSTRACT FROM AUTHOR]

Abstract: Introduction (Aim): Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS. Methods: We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups. Results: We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case. Conclusion: As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value. [Copyright &y& Elsevier]

Cardiac computed tomography (CT) is an evolving modality that includes a variety of examinations to assess the anatomy and pathology of the cardiac chambers, valves, myocardium, coronary arteries and veins, pericardium, aortic root, and central great vessels. The development of multidetector CT scanners with increasing numbers of detector rows, narrow section thicknesses, increasing scanner speeds, the ability for electrocardiographic gating, and radiation dose modulation allows the performance of CT coronary arteriography. Computed tomography coronary arteriography enables the assessment of multiple types of cardiac pathology, including intraluminal coronary arterial plaque formation, coronary artery stenosis, congenital anomalies, coronary artery aneurysms, sequelae of cardiac ischemia, and the assessment of prior vascular interventions, while providing information about cardiac and valvular function. Noncardiac structures included in cardiac CT examinations must also be evaluated. This guideline attempts to maximize the probability of detecting cardiac abnormalities with cardiac CT. American College of Radiology requirements for physicians and personnel performing examinations are also addressed and will become applicable by July 1, 2008. [Copyright &y& Elsevier]

Magnetic resonance imaging (MRI) is an established imaging modality, recognized for its value in the assessment and monitoring of a wide range of cardiac pathology. It can provide physiologic as well as anatomic information. Image interpretation requires both well-developed MRI skills and knowledge of cardiac pathology. Radiologists, because of their extensive experience in MRI, have an important role in its application in the heart. The guidelines presented here are an educational tool designed to assist practitioners in providing the best possible patient care via the diagnostic methods of cardiac MRI. American College of Radiology requirements for physicians and personnel performing and interpreting cardiac MRI, which will become applicable by July 1, 2008, are also presented. [Copyright &y& Elsevier]

Many cardiac diseases are caused by the abnormal propagation of electrical waves. Previous experimental and modelling work is reviewed, then a detailed study of the mathematics of cardiac propagation is presented. Pathologies are examined in the context of the models by varying parameters in the models to mimic different pathological states. Ionic models of cells are simplified to form analytically tractable models of the propagation of electrical cardiac waves. The roles that sodium channel activation and inactivation play in determining the conduction velocity are studied in detail, and the roles of resting potential currents in conduction block are calculated. The effect of curvature on the conduction velocity is examined, and the conditions in which curvature leads to conduction block and fibrillation are discussed. Hyperkalaemia (important during ischaemia) is modelled, and the model correctly describes the bi-phasic relation between propagation velocity and extracellular potassium. [Copyright &y& Elsevier]

• Among our sample of patients who died with COVID-19, the majority had chronic changes secondary to atherosclerotic and hypertensive cardiovascular disease. • Despite severe elevations in inflammatory markers, prevalence of cardiac inflammatory infiltrates and myocyte necrosis are uncommon. • Continued autopsy examinations are needed to further characterize this disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is commonly associated with myocardial injury and heart failure. The pathophysiology behind this phenomenon remains unclear, with many diverse and multifaceted hypotheses. To contribute to this understanding, we describe the underlying cardiac findings in fifty patients who died with coronavirus disease 2019 (COVID-19). Included were autopsies performed on patients with a positive SARS-CoV-2 reverse-transcriptase-polymerase-chain reaction test from the index hospitalization. In the case of out-of-hospital death, patients were included if post-mortem testing was positive. Complete autopsies were performed according to a COVID-19 safety protocol, and all patients underwent both macroscopic and microscopic examination. If available, laboratory findings and echocardiograms were reported. The median age of the decedents was 63.5 years. The most common comorbidities included hypertension (90.0%), diabetes (56.0%) and obesity (50.0%). Lymphocytic inflammatory infiltrates in the heart were present in eight (16.0%) patients, with focal myocarditis present in two (4.0%) patients. Acute myocardial ischemia was observed in eight (16.0%) patients. The most common findings were myocardial fibrosis (80.0%), hypertrophy (72.0%), and microthrombi (66.0%). The most common causes of death were COVID-19 pneumonia in 18 (36.0%), COVID-19 pneumonia with bacterial superinfection in 12 (24.0%), and COVID-19 pneumonia with pulmonary embolism in 10 (20.0%) patients. Cardiovascular comorbidities were prevalent, and pathologic changes associated with hypertensive and atherosclerotic cardiovascular disease were the most common findings. Despite markedly elevated inflammatory markers and cardiac enzymes, few patients exhibited inflammatory infiltrates or necrosis within cardiac myocytes. A unifying pathophysiologic mechanism behind myocardial injury in COVID-19 remains elusive, and additional autopsy studies are needed. [ABSTRACT FROM AUTHOR]

• Congenitally corrected transposition is a rare form of congenital heart disease. • Characterized by inversion of the ventricles and atrioventricular valves. • Examine chordae tendinae insertion and valve relationships to identify inversion. • Fibrous continuity of atrioventricular and semilunar valves is characteristic of the mitral valve. • Muscular discontinuity of atrioventricular and semilunar valves is characteristic of the tricuspid valve. Congenitally corrected transposition of the great arteries (cc-TGA, also known as L-transposition) is a rare condition that represents approximately 0.5% of congenital heart disease. It is characterized by atrioventricular and ventriculoarterial discordance. Patients with cc-TGA are at risk for cardiac arrhythmias due to abnormalities of the conduction system. We present an autopsy case of a 49-year-old man with cc-TGA who died unexpectedly, likely as a result of a fatal arrhythmia. This case illustrates the cardiac pathology characteristic of cc-TGA and describes how to grossly identify inversion of the atrioventricular valves. [ABSTRACT FROM AUTHOR]

High pre-slaughter mortality rates of Atlantic salmon (Salmo salar L.) are a reoccurring welfare issue and economic burden in aquaculture. Sudden death immediately prior to slaughter is particularly problematic given the considerable resources invested to reach this stage. Although the underlying causes of such mortality are largely unknown, cardiac deformities and diseases have become increasingly prevalent observations in deceased fish. The factors leading to this pathology remains to be revealed. Thus, we presently examined if intensive smolt production and concordant fast growth rates in young fish is associated with altered cardiac morphology at later production stages in Atlantic salmon. The observed alterations were subsequently related to mortality risk following de-lousing in a facility with a cardiomyopathy syndrome (CMS) outbreak. We observed that intensive smolt production is indeed associated with slower growth rates at sea, distinct pathological cardiac morphological alterations, and expression of cardiac pathology markers. Moreover, the observed cardiac alterations co-occurred with CMS-related cardiac rupture at a different production facility. The present study demonstrates a clear link between pace of growth at early rearing stages and cardiac deformities later in life. Furthermore, these cardiac deformities are associated with cardiac rupture and mortality in individuals with CMS during delousing. We therefore believe that a slower pace of smolt production improves cardiac health and reduces the risk of mortality during CMS outbreaks. • Intensive smolt production of Atlantic salmon is associated with slow growth at sea. • Fast smolt production results in morphological deviations of the heart. • The same morphological deviations increase risk of CMS-related cardiac rupture. • Growth in early rearing stages links to cardiac health later in life. • Rapid growth at sea rather than in hatchery is preventive of cardiac deformities. [ABSTRACT FROM AUTHOR]

The neuronal ceroid lipofuscinoses (NCLs) are mostly seen as diseases affecting the central nervous system, but there is accumulating evidence that they have co-morbidities outside the brain. One of these co-morbidities is a decline in cardiac function. This is becoming increasingly recognised in teenagers and adolescents with juvenile CLN3, but it may also occur in individuals with other NCLs. The purpose of this review is to summarise the current knowledge of the structural and functional changes found in the hearts of animal models and people diagnosed with NCL. In addition, we present evidence of structural changes that were observed in a systematic comparison of the cardiomyocytes from CLN3Δex7/8 mice. • NCLs have a cardiac co-morbidity, best described for CLN3. • This review summarises cardiac phenotypes in animal models and NCL patients. • The cardiac phenotype is variable and to date not well studied. • Bradycardia, left ventricular hypertropy and conduction problems are common. [ABSTRACT FROM AUTHOR]

Background and Purpose: Various pathogenesis are presumed to be involved in the etiology of embolic stroke of undetermined source (ESUS), which has a high recurrence rate, and much remains unknown about the clinical subtype of recurrent stroke. The purpose of this study was to clarify the pathogenesis of ESUS using the ASCOD classification for ESUS patients and to examine the factors involved in the recurrence of ischemic stroke.Methods: The subjects of this study were 236 of these patients who fulfilled the criteria for ESUS. The rate of stroke recurrent, subtype of recurrent ischemic stroke, and new-onset atrial fibrillation (AF) in these patients were surveyed retrospectively, and each patient was graded for the A, S, and C categories of the ASCOD classification.Results: Ischemic stroke recurred in 32 patients during the follow-up period (7 days to 12.9 years [median 54.3 months]), and new-onset AF was seen in 44 (18.6%) patients. The most subtype of recurrent ischemic stroke was ESUS again (19 patients). Multivariate analysis with a Cox proportional hazards model, the S score (hazard ratio 5.21; 95% confidence interval (CI) 2.38-11.42; P < .001) and the number of A, S, C categories (hazard ratio 1.90; 95% CI 1.14-3.10; P = .013) were factors significantly related to recurrent ischemic stroke.Conclusions: Assessment of comorbid conditions in ESUS patients based on the ASCOD classification may be useful in predicting the likelihood of recurrence of ischemic stroke. [ABSTRACT FROM AUTHOR]

Abstract: The use of anabolic androgenic steroids (AAS) has been associated with different adverse effects, some of which potentially lethal. Most users of AAS are male, but the prevalence of such use appears to be increasing in females. Here we present a sudden unexpected death in a female fitness athlete with a possible connection to use of doping agents. [Copyright &y& Elsevier]