Abstract
Subendocardial hemorrhages (SEH) occur after cardiac injuries and resuscitation as well as secondary to noncardiac injuries comprising head injuries, infectious diseases, intoxications, hemorrhagic diathesis, abdominal trauma, asthma, and hypovolemic shock. In particular, the common incidence of SEH in intracranial lesions led to the suggestion that the phenomenon is mediated by the autonomic nervous system via hypersecretion of catecholamines. Other modes of SEH induction are also discussed, especially a sudden hypotension followed by subendocardial myocardial cell necrosis. Furthermore, animal experiments with adult miniature swine led to the suggestion that high-impact accelerations could provoke the formation of SEH. Human experiments, however, point out that humans do not appear to have catecholamine levels (cardiac or systemic) as high as those observed in miniature swine during high-impact acceleration exposure and it is widely accepted that the lesions in miniature swine develop as a consequence of a somewhat unique form of the porcine stress syndrome. SEH are located in the upper part of the interventricular septum, the opposing papillary muscles, and adjacent trabeculae carneae of the free wall of the left ventricle. A part of the conducting system is located in the subendocardium, and the left branches of the atrioventricular bundle are localized in the region in which SEH are most commonly seen at autopsy. Therefore, the predisposition of the subendocardium to ischemia may suggest a mechanism for the explanation of ventricular arrhythmia and sudden death. Additionally, ischemic lesions of the papillary muscles of the left ventricle can cause mitral insufficiency, thus contributing to heart failure.
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References
Knight B. Forensic Pathology. Arnoldt, London, Sidney, Auckland, 1996.
Rajs J. Left ventricular subendocardial haemorrhages. A study of their morphology, pathogenesis and prognosis. Forensic Sci 1977;10:80–103.
Caesar R. Subendokardiale Blutungen. In: Remmele W, ed. Pathologie, Vol 1. Springer, Berlin, Heidelberg, New York, 1999, p. 243.
Harruff RC. Subendocardial hemorrhages in forensic pathology autopsies. Am J Forensic Med Pathol 1993;14:284–288.
Yoshida K, Ogura Y, Wakasugi C. Myocardial lesions induced after trauma and treatment. Forensic Sci Int 1992;54:181–189.
Smith RP, Tomlinson BE. Subendocardial haemorrhages associated with intracranial lesions. J Pathol Bacteriol 1954;68:327–334.
Matsui T, Baba M. Death from asthma in children. Acta Paediatr Jpn 1990;32:205–208.
Sheehan HL, Murdoch R. Postpartum necrosis of the anterior pituitary: pathological and clinical aspects. J Obstet Gynaecol Br Emp 1938;45:456–488.
Sheehan HL, Sutherland AM. The pathology of heart disease in pregnancy. J Obstet Gynaecol Br Emp 1940;47:597–668.
Sheehan HL. The pathology of obstetric shock. J Obstet Gynaecol Br Emp 1939;46:218–231.
Sheehan HL. Subendocardial hemorrhages in shock. Lancet 1940;1:831,832.
Tsokos M, Türk EE, Uchigasaki S, Püschel K. Pathologic features of suicidal complete decapitations. Forensic Sci Int 2004;139:95–102.
Weintraub BM, McHenry LC. Cardiac anomalies in subarachnoid hemorrhage: a résumé. Stroke 1974;5:384–392.
McLeod AA, Neil-Dwyer G, Meyer CHA, Richardson PL, Cruickshank J, Bartlett J. Cardiac sequelae of acute head injury. Br Heart J 1982;47:221–226.
Sevitt S. Reflections on some problems in the pathology of trauma. J Trauma 1970;10:962–973.
McGovern VJ. Hypovolemic shock with particular reference to the myocardial and pulmonary lesions. Pathology 1980;12:63–72.
Koskelo P, Punsar S, Sipilae W. Subendocardial haemorrhage and E.C.G. changes in intracranial bleeding. Br Med J 1964;5396:1479,1480.
Leslie JB. Incidence and aetiology of perioperative hypertension. Acta Anaesthesiol Scand Suppl 1993;99:5–9.
Cechetto DF, Wilson JX, Smith KE, Wolski D, Silver MD, Hachinski VC. Autonomic and myocardial changes in middle cerebral artery occlusion: stroke models in the rat. Brain Res 1989;502:296–305.
Vögelin HP, Jutzi H, Gertsch M. EKG-und kardiale Veränderungen bei akutem Hirnschaden. Schweiz Med Wochenschr 1989;119:461–466.
Marion DW, Segal R, Thompson ME. Subarachnoid hemorrhage and the heart. Neurosurgery 1986;18:101–106.
Varga T, Szabo A. Herzveränderungen bei akutem intrakraniellen Druckanstieg. Z Rechtsmed 1978;80:311–318.
Guy C, Eliot RS. The subendocardium of the left ventricle: a physiologic enigma. Chest 1970;58:555,556.
Keil W, Rothämel T, Tröger HD. Subendokardiale Hämorrhagien aus forensisch-medizinischer Sicht. Beitr Gerichtl Med 1991;49:45–53.
Burton RR, MacKenzie WF. Cardiac pathology associated with high sustained +Gz: I. Subendocardial hemorrhage. Aviat Space Environ Med 1976;47:711–717.
Fassbender H, Wengler G. Zur Aetiologie der subendokardialen Blutung. Virchows Arch 1952;321:138–141.
Eppinger H, Rothberger J. Über die Folgen der Durchschneidung der Tawaraschen Schenkel des Reizleitungssystems. Z klin Med 1910;70:1–20.
Mazzella H, Acosta CB, Guemberena L. Subendocardial hemorrhages provoked by carotid occlusion and section of the vagus nerves. Acta Physiol Lat Am 1964;14:202–206.
Gauer OH, Henry JP. Subendocardial hemorrhage in hypotension treated with norepinephrine. Am Heart J 1964;67:713,714.
Reichenbach DD, Benditt EP. Catecholamines and cardiomyopathy: the pathogenesis and potential importance of myofibrillar degeneration. Hum Pathol 1970;1:125–150.
Neil-Dwyer G, Walter P, Cruickshank JM, Doshi B, O’Gorman P. Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid hemorrhage. Br Med J 1978;2:990–992.
Bove EL, Argenta LC, Cimmino VM, Brown JW, Nishiyama RH, Kirsh MM. The morphologic effects of simultaneous infusion of levarterenol and phentolamine on the canine myocardium. J Thorac Cardiovasc Surg 1975;70:701–706.
Vormittag E, Keiler A. Die Wirkung von Oxprenolol auf die Herzfunktion im hypovolämischen Schock des Hundes. Arzneimittelforschung 1979;29:1534–1538.
Cruickshank J, Neil-Dwyer G, Degaute JP, et al. Reduction of stress/catecholamine-induced cardiac necrosis by β1-selective blockade. Lancet 1987;2:585–589.
Pareja M, Sanchez O, Lorita J, Soley M, Ramirez I. Activated epidermal growth factor receptor (ErbB1) protects the heart against stress-induced injury in mice. Am J Physiol Regul Integr Comp Physiol 2003;285:R455–R462.
Chiu CJ, Mersereau WA, Scott HJ. Subendocardial hemorrhagic necrosis. The role of direct mechanical trauma on the endocardium. J Thorac Cardiovasc Surg 1972;64:66–75.
Balazs T. Cardiotoxicity of adrenergic bronchodilator and vasodilating antihypertensive drugs. In: Balazs T, ed. Cardiac Toxicology. CRC Press, Boca Raton, FL, 1981, pp. 61–72.
Mesfin GM, Higgins MJ, Robinson FG, Zhong WZ. Relationship between serum concentrations, hemodynamic effects, and cardiovascular lesions in dogs treated with minoxidil. Toxicol Appl Pharmacol 1996;140:337–344.
Martin AM, Hackel DB, Entman ML, Capp MP, Spach MS. Mechanisms in the development of myocardial lesions in hemorrhagic shock. Ann NY Acad Sci 1969;156:79–90.
Kleinman WM, Krause SM, Hess ML. Differential subendocardial perfusion and injury during the course of gram-negative endotoxemia. Adv Shock Res 1980;4:139–152.
Archie JP Jr., Mertz WR. Myocardial oxygen delivery after experimental hemorrhagic shock. Ann Surg 1978;187:205–210.
Hackel DB, Wagner GS. Acute circumferential subendocardial infarction. Clin Cardiol 1992;15:373–376.
Sherman IA, Grayson J. Function of the coronary arterial collateral network in healthy myocardium: studies of peripheral coronary pressure in the dog. Can J Physiol Pharmacol 1980;58:134–140.
Lorenzen I. Vascular connective-tissue changes induced by catecholamines and thyroid hormone. In: Asboe-Hansen G, ed. Hormones and Connective Tissue. Munksgaard, Copenhagen, 1966, p. 136.
Hernandez-Meilan O, Hernandez-Meilan M, Machado-Curbelo C. Capablanca’s stroke: an early case of neurogenic heart disease. Cuban-world-champion of chess 1921–1927. J Hist Neurosci 1998;7:137–140.
Kaste M, Hernesniemi J, Somer H, Hillbom M, Konttinen A. Creatine kinase isoenzymes in acute brain injury. J Neurosurg 1981;55:511–515.
Kaste M, Somer H, Konttinen A. Heart type creatine kinase isoenzyme (CK MB) in acute cerebral disorders. Br Heart J 1978;40:802–805.
Fireman Z, Yust I, Zahavi J, Kahn Y, Abramov LA. Subendocardial infarction and thrombocytopenia. Postgrad Med J 1979;55:36–38.
Karch SB, Billingham ME. The pathology and etiology of cocaine-induced heart disease. Arch Pathol Lab Med 1988;112:225–230.
Price LM, Poklis A, Johnson DE. Fatal acetaminophen poisoning with evidence of subendocardial necrosis of the heart. J Forensic Sci 1991;36:930–935.
Pack RJ, Alley MR, Dallimore JA, Lapwood KR, Burgess C, Crane J. The myocardial effects of fenoterol, isoprenaline and salbutamol in normoxic and hypoxic sheep. Int J Exp Pathol 1994;75:357–362.
Than T, Francis N, Tin Nu S, et al. Contribution of focal haemorrhage and microvascular fibrin deposition to fatal envenoming by Russell’s viper (Vipera russelli siamensis) in Burma. Acta Trop 1989;46:23–38.
Bose TK, Basu RK, Biswas B, De JN, Majumdar BC, Datta S. Cardiovascular effects of yellow oleander ingestion. J Indian Med Assoc 1999;97:407–410.
Blood-Siegfried J, Nyska A, Lieder H, et al. Synergistic effect of influenza a virus on endotoxin-induced mortality in rat pups: a potential model for sudden infant death syndrome. Pediatr Res 2002;52:481–490.
Burton RR, MacKenzie WF. Heart pathology associated with exposure to high sustained +Gz. Aviat Space Environ Med 1975;46:1251–1253.
Erickson HH, Sandler H, Stone HL. Cardivascular function during sustained +Gz stress. Aviat Space Environ Med 1976;47:750–758.
Gillingham KK, Crump PP. Changes in clinical cardiologic measurements associated with high +Gz stress. Aviat Space Environ Med 1976;47:726–733.
Burns JW, Laughlin MH, Witt WM, Young JT, Ellis JP Jr. Pathophysiologic effects of acceleration stress in the miniature swine. Aviat Space Environ Med 1983;54:881–893.
Laughlin MH. An analysis of the risk of human cardiac damage during +Gz stress: a review. Aviat Space Environ Med 1982;53:423–431.
Hellerich U, Pollak S. Airplane crash. Traumatologic findings in cases of extreme body disintegration. Am J Forensic Med Pathol 1995;16:320–324.
Zhu BL, Fujita MQ, Quan L, et al. A sudden death due to cardiac conduction system injury from a blunt chest impact. Leg Med (Tokyo) 1999;1:266–269.
Plack RH, Hutchins GM, Brinker JA. Conduction system injury after aortic valve dilation in the dog single-versus double-balloon catheters. Angiology 1990;41:929–935.
Ford SE, Manley PN. Indwelling cardiac catheters. An autopsy study of associated endocardial lesions. Arch Pathol Lab Med 1982;106:314–317.
Karch SB. Resuscitation-induced myocardial necrosis: catecholamines and defibrillation. Am J Forensic Med Pathol 1987;8:3–8.
Matsuda H, Seo Y, Takahama K. A medico-legal approach to the myocardial changes caused by transthoracic direct current countershock. Nippon Hoigaku Zasshi 1997;51:11–17.
Markiewicz W, Amikam S, Roguin N, Riss E. (1975) Changing haemodynamics in patient with papillary muscle dysfunction. Br Heart J 1975;37:445–448.
Gould L, Reddy CVR, Vecchiotti HJ, Gomprecht RF. Observations on papillary muscle dysfunction. Am Heart J 1974;87:674,675.
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Seidl, S. (2005). Subendocardial Hemorrhages. In: Tsokos, M. (eds) Forensic Pathology Reviews. Forensic Pathology Reviews, vol 2. Humana Press. https://doi.org/10.1385/1-59259-872-2:293
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DOI: https://doi.org/10.1385/1-59259-872-2:293
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