Microscopic Pathology of Intramural Coronary Arteries and Arterioles of the Left Ventricle in Arterial Hypertension

Abstract

Pathological alterations in the small intramyocardial arterial or venous vascular tracts are often called small vessel disease of the myocardium. In its narrower sense, the term “small vessel disease of the heart” is often used synonymously for intramyocardial arterial vascular lesions of degenerative origin. Other terms for such vascular alterations are “arteriolosclerosis of the myocardium” [28, 44], “intramural coronary arteriosclerosis” [26], “intramyocardial arteriopathy” [35] or “small coronary disease” (James 1976, personal communication). It is precisely in this area of arterial vascular lesions of a degenerative type that our knowledge is still inadequate. The nature, localization, frequency, aetiology and functional significance of these pathological vascular alterations, which we understand as intramyocardial microarteriopathy, receive very different treatment in a long series of morphological investigations [3, 13, 14, 24, 29, 42, 44]. Hypertension has been one of the most researched factors in discussing the occurence of intramyocardial microarteriopathy, and some authors believe that there exists a typical hypertension-dependent type of vascular damage in the myodardium [3, 20, 33, 37].

With the support of German Research Society under the terms of Special Research Project 89 - Cardiology Gottingen -