Ischaemic Heart Disease

Abstract

Ischaemic heart disease, as the result of impaired blood supply, is currently the leading cause of cardiac failure and death. Ischaemic heart disease refers to a group of clinico-pathological symptoms including angina pectoris, acute myocardial infarction, chronic ischemic heart disease, as well as heart failure and sudden cardiac death. Coronary artery thrombosis is the most common cause of acute myocardial infarction and sudden cardiac death. A thrombotic event is the result of two different processes: plaque disruption and endothelial erosion. The morphology of a “vulnerable plaque” is more clinically indicative than the plaque volume and the degree of luminal stenosis. However, identification of patients with vulnerable plaques remains very challenging and demands the development of new methods of coronary plaque imaging. Sudden death resulting from ventricular fibrillation or heart block frequently complicates coronary thrombosis, accounting for up to 50% of mortality. If a coronary artery is occluded for more than 20 min irreversible damage to the myocardium occurs. Timely coronary recanalisation and myocardial reperfusion limits the extent of myocardial necrosis, but may induce “reperfusion injuries”, stunned myocardium or reperfused myocardial hemorrhagic infarcts, all of which are related to infarct size and coronary occlusion time. Reperfusion injuries have been described after cardiac surgery, percutaneous transluminal coronary angioplasty and fibrinolysis. A prolonged imbalance between the supply of and demand for myocardial oxygen and nutrition leads to hibernating myocardium, a subacute, acute or chronic state of myocardial ischemia. Ischaemic heart disease is believed to be the underlying cause of heart failure in approximately two thirds of patients, resulting from acute and/or chronic injury to the heart.