title: Involvement of the microvasculature in the pathogenesis of terlipressin-related myocardial infarction.
abstract: We report an autopsy case of a 24-year-old man with diagnoses of advanced alcoholic liver cirrhosis, portal hypertension, and esophageal variceal bleeding that presented extensive myocardial infarction after treatment with terlipressin. On postmortem examination the cut surface of the heart presented myocardial infarction implicating the left ventricle free wall, apex of the heart and ventricular septum. Light microscopic examination revealed that the extensive area of cardiac infarction was the result of the sum of diffuse foci of microinfarction of various ages interspersed with small clusters of preserved myocytes. Moreover, the epicardial vessels were patent while the small intramyocardial vessels presented thickened wall, apparent reduction in lumen diameter and disruption of endothelial cells indicative of spasm. The observations in this case allow clear insight into the involvement of the microcirculation in the pathogenesis of myocardial infarction with the use of terlipressin.
authors.affiliation: Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Carmo
authors.affiliation: Department of Medicine, Division of Gastroenterology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Diego C
authors.initials: DC
authors.lastname: Baima
authors.affiliation: Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Valdecir
authors.initials: V
authors.lastname: Blefari
authors.affiliation: Department of Medicine, Division of Gastroenterology, Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Vaniela
authors.initials: V
authors.lastname: Zonta
authors.affiliation: Department of Medicine, Division of Gastroenterology, Ribeirão Preto Medical School, University of São Paulo, Brazil ledatron@fmrp.usp.br.
authors.forename: Luiz Ea
authors.initials: LE
authors.lastname: Troncon
authors.affiliation: Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Brazil.|Marcos A Rossi passed away on 9 May 2013.
authors.forename: Marcos A
authors.initials: MA
authors.lastname: Rossi
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects; D001344:Autopsy; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000503:physiopathology; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D055806:Microvessels / Q000187:drug effects / Q000473:pathology; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000473:pathology*; D000077585:Terlipressin; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin
keywords: Terlipressin; liver cirrhosis; microvasculature; myocardial infarction; upper gastrointestinal bleeding; vasospasm