The Pathophysiology of Atherosclerosis of the Coronary Arteries and the Changes that Predispose to Ischemic Heart Disease

  • John T. Fallon


Each year, over a million Americans have myocardial infarctions and over a half a million die from ischemic heart disease and its complications. During the past decade, both the incidence of myocardial infarction and the mortality of ischemic heart disease have decreased. It is unclear why the former has occurred, although it is suggested to be a consequence of the recognition of the major risk factors of coronary artery disease and the public health measures applied to reduce these risk factors. The decline in mortality of acute myocardial infarction is partially explained by the introduction of new medical and surgical therapies directed toward its major complications. Despite these apparently successful interventions, ischemic heart disease remains the number one cause of mortality in Western man. Although a great deal has been learned about the major cause of ischemic heart disease, i.e., coronary atherosclerosis, this disease remains an enigma, both in its pathogenesis and in the biology of its complications [1].


Smooth Muscle Cell Ischemic Heart Disease Coronary Thrombosis Mural Thrombus Necrotic Debris 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Friedman M: The pathogenesis of coronary plaques, thromboses, and hemorrhages: an evaluative review. Circulation(Suppl 3)51–52: 34–40, 1975.Google Scholar
  2. 2.
    Roberts CS, Roberts WC: Cross-sectional area of the proximal portions of the three major epicar dial coronary arteries in 98 necropsy patients with different coronary events: relationship to heart weight, age and sex. Circulation 62: 953–959, 1980.PubMedGoogle Scholar
  3. 3.
    Ross R, Glomset JA: The pathogenesis of atherosclerosis. N Engl J Med 285:369–377 and 420–425, 1976.Google Scholar
  4. 4.
    Edwards JE: Correlations in coronary arterial dis-ease. Bull NY Acad Med 33: 199–217, 1957.Google Scholar
  5. 5.
    Fuchs RM, Becker LC: Pathogenesis of angina pectoris. Arch Intern Med 142: 1685–1692, 1982.PubMedCrossRefGoogle Scholar
  6. 6.
    Roberts WC: The coronary arteries and left ventricle in clinically isolated angina pectoris: a necropsy analysis. Circulation 54: 388–390, 1976.PubMedGoogle Scholar
  7. 7.
    Vlodaver Z, Neufeld HN, Edwards JE: Pathology of angina pectoris. Circulation 46: 1048–1064, 1972.PubMedGoogle Scholar
  8. 8.
    Horie T, Sekiguchi M, Hirosawa K: Case reports: relationship between myocardial infarction and preinfarction angina—a histopathological study of coronary arteries in two sudden death cases employing serial section. Am Heart J 94: 81–88, 1978.CrossRefGoogle Scholar
  9. 9.
    Roberts WC, Virmani R: Quantification of coronary arterial narrowing in clinically-isolated unstable angina pectoris: an analysis of 22 necropsy patients. Am J Med 67: 792–799, 1979.PubMedCrossRefGoogle Scholar
  10. 10.
    Fallon JT: Pathology of arterial lesions amenable to percutaneous transluminal angioplasty. Am J Radiol 135: 913–916, 1980.Google Scholar
  11. 11.
    Levin DC, Fallon JT: Significance of the angiographic morphology of localized coronary stenoses: histopathologic correlations. Circulation 66: 316–320, 1982.PubMedCrossRefGoogle Scholar
  12. 12.
    Friedman M, Van Den Bovenkamp GL: The pathogenesis of a coronary thrombus. Am J Pathol 48: 19–44, 1966.PubMedGoogle Scholar
  13. 13.
    Ridolfi RL, Hutchins GM: The relationship between coronary artery lesions and myocardial infarcts: ulceration of atherosclerotic plaques precipitating coronary thrombosis. Am Heart J 93: 468–486, 1977.PubMedCrossRefGoogle Scholar
  14. 14.
    Constantinides P: Plaque fissures in human coronary thrombosis. J Atheroscler Res 6: 1–17, 1966.CrossRefGoogle Scholar
  15. 15.
    Bouch DC, Montgomery GL: Cardiac lesions in fatal cases of recent myocardial ischemia from a coronary care unit. Br Heart J 32: 795–803, 1970.PubMedCrossRefGoogle Scholar
  16. 16.
    Chapman I: Morphogenesis of occluding coronary artery thrombosis. Arch Pathol 80: 256–261, 1965.PubMedGoogle Scholar
  17. 17.
    Barger AC, Beeuwkes R, Lainey LL, Silverman KJ: Hypothesis: vasorum and neovascularization of human coronary arteries—possible role in the pathophysiology of atherosclerosis. N Engl J Med 310: 175–177, 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Paterson JC: Capillary rupture with intimal hemorrhage as a causative factor in coronary thrombosis. Arch Pathol 25: 474–487, 1938.Google Scholar
  19. 19.
    Horn H, Finkelstein LE: Arteriosclerosis of the coronary arteries and the mechanism of their occlusion. Am Heart J 19: 655–682, 1940.CrossRefGoogle Scholar
  20. 20.
    Wartman WB: Occlusion of the coronary arteries by hemorrhage into their walls. Am Heart J 15: 459–470, 1938.CrossRefGoogle Scholar
  21. 21.
    Freidman M, Van den Bovenkamp GJ: The patho-genesis of coronary intramural heomorrhages. Br J Exp Pathol 47: 347–355, 1966.Google Scholar
  22. 22.
    Oliva PB: Pathophysiology of acute myocardial infarction, 1981. 94: 236–250, 1981.Google Scholar
  23. 23.
    Maseri A, Chierchia S, L’Abbate A: Pathogenetic mechanisms underlying the clinical events asso-ciated with atherosclerosis heart disease. Circulation (Suppl 5 ) 62: 3–13, 1980.Google Scholar
  24. 24.
    De Wood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT: Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 303: 897–902, 1980.CrossRefGoogle Scholar
  25. 25.
    Zelinger AB, Abramowitz BM, Schick EC, Ryan TJ: Variant angina culminating in coronary thrombosis and myocardial infarction. Chest 82: 188–190, 1982.PubMedCrossRefGoogle Scholar
  26. 26.
    MacAlpin RN: Relation of coronary arterial spasm to sites of organic stenosis. Am J Cardiol 46: 143–153, 1980.PubMedCrossRefGoogle Scholar
  27. 27.
    Lusby RJ, Ferrell LD, Ehrenfeld WK, Stoney RJ, Wylie EJ: Carotid plaque hemorrhage. Arch Surg 117: 1479–1488, 1982.PubMedGoogle Scholar
  28. 28.
    Barker LA, Ritchie JL: The role of platelets in acute vascular events. Circulation (Suppl 5 ) 62: 13–18, 1980.Google Scholar
  29. 29.
    Chandler AB: Mechanisms and frequency of thrombosis in the coronary circulation. Thromb Res (Suppl 1 ) 4: 3–23, 1974.Google Scholar
  30. 30.
    Neill WA, Ritzmann LW, Seiden R: The patho-physiologic basis of acute coronary insufficiency: observations favoring the hypothesis of intermittent reversible coronary obstruction. Am Heart J 94: 439–444, 1977.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston/Dordrecht/Lancaster 1985

Authors and Affiliations

  • John T. Fallon

There are no affiliations available

Personalised recommendations