Toxic Clause Samples

Toxic. Highly-Toxic Materials (POISON, TOX, HT) are materials which in small quantities can cause death or adverse health effects.

Toxic. Exposure to certain medically prescribed, recreational drugs and environmental metals/pollutants can result in toxic injury that affects the functional integrity of the myocardium (107,108). Toxic cardiomyopathy is an important aetiology to exclude in younger adults presenting with DCM, as substance abuse is a relatively common cause of heart failure in patients less than 65 years of age (109). The suggested pathophysiology seems to vary depending on the toxin, and may be due to direct toxic myocardial effects causing apoptosis and cellular death for example by interference and alteration of the mitochondrial bioenergetics or could be indirect, for example through catecholamine-induced alterations of the electrophysiological properties which might subsequently induce functional changes (108–110). The transition from exposure to myocardial susceptibility and dysfunction are in reality likely to be more complex than any one mechanism at play, taking into account the individual’s underlying genetic predisposition, other medical comorbidities, in addition to consideration for dosage and duration of exposure to a particular toxin (108). Although withdrawal of the precipitating toxin tends to relieve symptoms and reverse cardiac dysfunction, patients with recreational drug abuse habits often contend with co- occurring mental health problems that can greatly impact outcomes by their influence on adherence to treatment plans and maintenance of sobriety from offending drugs (108,111). In a single-centre longitudinal evaluation of over 500 patients with an LVEF less than 40%, toxic cardiomyopathy due to recreational drug abuse accounted for almost 20% of younger patients presenting with presumed idiopathic DCM (112). Whilst the majority improved with cessation of the offending drug, alongside guideline directed medical therapy, relapse occurred in 32% of patients. This was associated with difficult mechanical circulatory support in those with refractory heart failure, who experienced an overall worse prognosis. Alcohol and chemotherapy-induced causes of cardiomyopathy have probably received the most attention of the toxic cardiomyopathy DCM subgroup, with attempts to characterise their differences from other forms of non-ischaemic cardiomyopathy, as well as establish the prognostic impact in patients. Whilst acute intake of excess alcohol can induce direct toxic effects to the myocardium manifesting as transient arrhythmic disease and mild LV contractile dysfunction...