Anaesthetic-related occurrence of early ventricular arrhythmias during acute myocardial ischaemia in rats

The cardiovascular responses of rats anaesthetised with different anaesthetic agents to acute coronary artery ligation were studied. Before thoracotomy, urethane-anaesthetised animals exhibited significantly lower blood pressures. Ligation of the left coronary artery induced a high incidence of ventricular tachycardia or fibrillation in rats anaesthetised with pentobarbitone, urethane, or ether inhalation followed by chloralose. Ketamine-anaesthetised animals had a significantly lower incidence of ventricular arrhythmias. The mortality rate was also lower, though not statistically significant. However, all groups of rats showed essentially similar blood pressure and heart rate changes following coronary artery ligation as well as the time of onset of ventricular tachycardia or fibrillation. The findings demonstrate the influence of anaesthetics on the occurrence of early ventricular arrhythmias following acute coronary artery ligation in rats.     

Thyroid hormone and myocardial ischaemia

Thyroid hormone has various effects on the cardiovascular system and its effects on cardiac contractility, heart rhythm and vascular function has long been recognized. However, new evidence is emerged on the importance of thyroid hormone in the response of the myocardium to ischaemic stress and cardiac remodelling following myocardial infarction. Based on this new information, this review highlights the role of thyroid hormone in myocardial ischaemia and cardiac remodelling, the possible underlying mechanisms and the potential therapeutic implications. Thyroid hormone or analogs may prove new therapeutic agents for treating ischaemic heart disease.     

Signal transduction in myocardial ischaemia and reperfusion

Recent studies in the non-ischaemic myocardium indicated that drugs stimulating cAMP formation inhibit ₁-mediated inositol phosphate generation, while ₁-adrenergic stimulation lowered tissue CAMP levels, implicating cross-talk between ₁,- and -adrenergic signalling pathways in normal physiological conditions. Massive amounts of endogenous catecholamines, predominantly noradrenaline, are released during myocardial ischaemia and reperfusion, causing stimulation of both ₁- and -adrenergic receptors which, in turn, may contribute to intracellular Ca²⁺ overload and subsequent cell damage. Since no information is available regarding cross-talk in pathophysiological conditions, the aim of this study was to evaluate the interactions between ₁- and -adrenergic signalling pathways during different periods of ischaemia and reperfusion.Isolated rat hearts were perfused retrogradely for 30 min before being subjected to (i) 5–25 min global ischaemia and (ii) 1–5 min of reperfusion after 20 min global ischaemia. Drugs (prazosin, 10^–7 M; propranolol, 10^–6 M; phenylephrine 3 × 10^–5 M; isoproterenol 10^–9 M) were added 10 min before the onset of ischaemia and were present during reperfusion.Increasing periods of ischaemia caused an immediate rise and progressive lowering in tissue cAMP and Ins(1,4,5)P₃ levels respectively. In contrast, reperfusion caused an elevation in Ins(1,4,5)P₃ levels and reduced cAMP. Prazosin elevated cAMP levels during both ischaemia and reperfusion, while propranolol had no effects on tissue Ins(1,4,5)P_3–. The activity of the ₁-adrenergic signal transduction pathway appears to have an inhibitory effect on the activity of the -adrenergic system during ischaemia and reperfusion.     

Arrhythmias associated with myocardial ischaemia and infarction

The intention of this review has been to summarise the current state of knowledge regarding the arrhythmias induced by myocardial ischaemia and infarction. Both clinical and experimental aspects were considered. There has been some progress toward understanding the electrophysiological mechanisms responsible for the genesis of such arrhythmias but understanding is far from complete. We are still unable to trace the sequence of events which begin with the electrophysiological changes induced in cells by ischaemia and progress through macromechanisms such as re-entry, automaticity, etc., to the final arrhythmia. Exactly how the changes in individual cells translate into the macromechanisms is not known. Similarly, which macromechanism actually operate, and to what extent, is not known.We have very little information regarding the biochemical events responsible for the changes in intracellular potential seen with ischaemia. Similarly, we do not know whether arrhythmogenic mediators are involved in such a process. We have a fairly complete catalogue of the changes in biochemistry induced by ischaemia, but at the moment it is difficult to find causal relationships between such changes and ischaemia-induced disturbances in electrophysiology.Finally, we are in possession of a catalogue of drugs which may reduce the arrhythmias induced by ischaemia and infarction (both clinically and experimentally), but have no clear direction as how to develop the ideal antiarrhythmic (antifibrillatory) drugs.     

Experimental investigations in prolonged myocardial ischaemia. Note I. Biology of the myocardial fiber after transient myocardial fiber after transient myocardial ischaemia

The first ten days' evolution of post-ischaemic lesions of the premonitory or angina pectoris syndrome type was experimentally studied by the challenge of a short-term (10 and 15 min) ischaemia, of an adaptation to ischaemia and an adaptation followed by prolonged ischaemia (20 and 35 min). Worthy of note was the persistence of reversible lesions after short-term ischaemia and adaptation, and the progressive evolution towards cytolysis and cicatrization of some pancicellular foci after adaptation followed by prolonged ischaemia. The role of mitochondrial lesions, of lysosomal hydrolases, the inefficiency of renewed circulation, as well as problems of diagnosis are discussed.     

Experimental studies in transient myocardial ischaemia

The biology of the myocardium was studied under experimental conditions similar to angina pectoris. In some dogs the myocardium was adapted to ischaemia by progressive coronary occlusion of 1-5 min followed by restoration of circulation during 5 min. In other dogs adaption was followed by 20 to 35 min ischaemia. The animals were sacrificed immediately or after 2-10 days. Transient ischaemia produced less severe alterations then abrupt coronary obstruction. Adaptation followed by 20 and 35 min ischaemia induced foci that undergo cytolysis and scarring of maximum intensity on the 8th day. Activity of enzymes in the mitochondrial suspension, especially of cytochromoxidase, decreases and lysosomal hydrolases increase with focal necroses.     

Effects of L-carnitine in acute myocardial ischaemia

Data in the literature suggest that exogenous L-carnitine improves the metabolic function of ischaemic heart cells: it enhances the transport of long-chain fatty acids into the mitochondria, stimulates the slowed beta-oxidation, and moderates the accumulation of amphiphilic acyl esters. A study has therefore been made of the cardiac effects of L-carnitine in dog experiments (n = 8). The left anterior descending coronary artery (LAD) was isolated in anaesthetized, thoracotomized animals in situ. After a control occlusion and equilibration period, the LAD was again ligated at the time of L-carnitine infusion (100 mg/kg iv. during 10 min). The agent diminished the maximal conduction delay and the degree of epicardial ST-segment elevation in the ischaemic myocardial region, and the free fatty acid concentration of the arterial blood, but it did not influence the frequency of ventricular extrasystoles. The anti-ischaemic effect of L-carnitine was manifest only during the infusion, and its discontinuation was immediately followed by an enhanced ST-segment elevation. In the dose applied, the substance did not affect the heart rate, systemic mean arterial pressure, left ventricular end-diastolic pressure (LVEDP), or left ventricular contractility (LV dP/dtmax). In the canine myocardial infarction model employed it was observed that the duration of the anti-ischaemic effect of L-carnitine (100 mg/kg iv.) is very short, and it has no significant antiarrhythmic action.     

Mitochondrial phospholipid composition and microviscosity in myocardial ischaemia

Normothermic ischaemic arrest of the isolated perfused rat heart causes profound changes in mitochondrial ultrastructure. Since the mitochondrial membranes contain a high percentage of phospholipids, an evaluation of the effect of different periods of ischaemia on mitochondrial phospholipid content and fatty acid composition was made. The results showed that ischaemia had no effect on the content of the different phospholipid classes and no correlation was observed between ultrastructural changes and mitochondrial phospholipid content. However, the phospholipid fatty acid composition of several phospholipids showed marked changes. For example, with lysophosphatidylcholine a progressive increase in the percentage saturated fatty acids was observed with increasing periods of ischaemia, while a reduction occurred in lysophosphatidylethanolamine. To determine whether the ischaemia-induced changes in mitochondrial phospholipid fatty acid composition had an effect on the physical properties of the membrane, the microviscosity of mitochondrial preparations was studied, using the lipophilic probe, 1,6-diphenyl-1,3,5-hexatrine. Mitochondria isolated from ischaemic hearts showed a progressive increase in fluorescence polarization with longer periods of ischaemia, indicating an overall increase in microviscosity. This phenomenon may be responsible for the increased mitochondrial fragility which is characteristic of ischaemic damage.     

Effect of chloroquine in experimental myocardial ischaemia

The cardiac effects of the phospholipase A2 inhibiting agent chloroquine were studied in dogs, rats and cats. During left anterior descending coronary artery occlusion produced in anaesthetized mongrel dog, chloroquine pretreatment considerably reduced the epicardial ST-segment elevation in the ischaemic area, as well as the number of premature ventricular contractions. In conscious male Sprague-Dawley CFY rats it diminished the duration and prolonged the latency of appearance of the early post-infarction arrhythmias and increased the survival rate following coronary artery ligation. Chloroquine failed to affect the ventricular fibrillation threshold in the normoxic cat heart. The cardioprotective action of chloroquine could be explained at least partly by its antiphospholipase activity.     

Right ventricular function in acute myocardial ischaemia

A haemodynamic examination of 10 dogs was carried out at rest, during volume loading and after ligation of the right coronary artery in the presence of a closed pericardium. Ligation of the right coronary artery led to haemodynamic signs of depression of right ventricular function--a drop in systolic pressure and an increase in end diastolic pressure, together with a shift of the functional curve to the right and downwards. Overall performance of the heart (cardiac output and the mean systemic pressure, also fell. Our results show that the depression of the systolic function of the myocardium in the presence of right ventricular infarction can be an important factor in the genesis of low cardiac output syndrome observed in clinical situations. Its pathophysiological mechanisms and some of the clinical consequences are discussed.     

Elevation of plasma fibrinogen in silent myocardial ischaemia

High plasma levels of fibrinogen and plasminogen activator inhibitor (PAI-1) are reported to be correlated with coronary heart disease. Therefore the level of fibrinogen concentration in plasma was examined and verified for the possible correlation with the previously explored PAI-1 antigen and PAI-1 activity in the pathogenesis of premature atherosclerosis (Grzywacz et al., 1998, Blood Coagul Fibrinol. 9, 245-249). Examination included only men, aged 33-46 years, who were in a stable condition for at least six months after the acute event. They were divided into two subgroups: group A (n = 14) with and group B (n = 15) without ischaemic changes in 24 h Holter electrocardiogram. The number of involved vessels visible on the coronarography picture was similar in both groups. In the patients of group A the mean level of fibrinogen (3.92 vs 3.23 g/l, P < 0.05) was higher than in the controls (n = 15). No statistically differences were found between group B and control healthy subjects in any of the parameters measured. There were no correlation between fibrinogen concentration and PAI-1 antigen and activity levels, which were elevated in both groups of patients according to our previous study. Our results indicate that elevated levels of plasma fibrinogen and PAI-1 appeared in the group of patients with more severe disease, as revealed by silent myocardial ischaemia.     

The chemical and kinetic consequences of the modification of papain by N-bromosuccinimide.

Nonactivated papain was treated with N-bromosuccinimide at pH 4.75. The N-bromosuccinimide-modified enzyme was characterized by (1) the change in absorbance at 280 nm, (2) amino acid analysis, (3) separate chemical determinations of tryptophan and tyrosine (4) difference spectroscopy, and (5) an N-terminal residue determination. It is concluded that N-bromosuccinimide in sevenfold molar excess oxidizes one tryptophan and two to three tyrosine residues per molecule of nonactivated papain, without causing peptide chain cleavage. Kinetic studies with several substrates and competitive peptide inhibitors were performed at pH6 using the N-bromosuccinimide-modified papain. In addition, the kinetics of the modified enzyme with the substrate alpha-N-benzoyl-L-arginine ethl ester were studied in the region of pH 3.5-9.0. All substrates (and inhibitors) test, with the exception of alpha-N-benzyoyl-L-arginine p-nitroanilide, displayed approximately a two fold decrease in both kcat and Km (or Ki), relative to the native enzyme. It is concluded that the key tryptophan residue which is probably Trp-177.     

Protein modification by aldehydophospholipids and its functional consequences

Phospholipid aldehydes represent a particular subclass of lipid oxidation products. They are chemically reactive and can form Schiff bases with proteins and aminophospholipids. As chemically bound molecular entities they modulate the functional properties of biomolecules in solution and the surface of supramolecular systems including plasma lipoproteins and cell membranes. The lipid-protein and lipid-lipid conjugates may be considered the active primary platforms that are responsible for the biological effects of aldehydophospholipids, e.g. receptor binding, cell signaling, and recognition by the immune system. Despite the fact that aldehydophospholipids are covalently associated, they are subject to exchange between nucleophiles since their imine conjugates are not stable. As a consequence, aldehydophospholipids exist in a dynamic equilibrium between different "states" depending on the lipid and protein environment. Aldehydophospholipids may also contribute to the systemic administration and activity of oxidized phospholipids by inducing release of microparticles by cells. These effects are lipid-specific. Future studies should help clarify the mechanisms and consequences of these membrane-associated effects of "phospholipid stress". This article is part of a Special Issue entitled: Oxidized phospholipids-their properties and interactions with proteins.