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Myocardial Ischemia and Infarction

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Coronary Vasculature

Abstract

When a coronary artery is occluded, the reduction of blood flow results in (1) tissue hypoxia, (2) an accumulation of metabolic products, and (3) failure in substrate delivery. Therefore, ischemia has a greater impact on the tissue supplied by the occluded artery than does hypoxia in the absence of ischemia. The magnitude of tissue injury depends on both the degree and the duration of the ischemia. Using electron microscopy and measurements of regional myocardial perfusion, my colleagues and I correlated cardiomyocyte changes (reversible vs. irreversible) with the magnitude of the perfusion decrement [1]. Other investigators have determined that in canine hearts subjected to a <10 % reduction in blood flow, cardiomyocyte death first appears after about 20 min [2, 3]. This topic is discussed in a subsequent section of this chapter. Clinically, ischemic myocardial injury is manifested by (1) cardiomyocyte death, (2) contractile dysfunction, (3) arrhythmias, and (4) microvascular dysfunction [4].

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Abbreviations

CFI:

Collateral flow index

EC:

Endothelial cell

FGF:

Fibroblast growth factor

HIF:

Hypoxia-inducible factor

IPC:

Ischemic preconditioning

IPost:

Ischemic postconditioning

IR:

Ischemia/reperfusion

MCVR:

Minimal coronary vascular resistance

MI:

Myocardial infarction

ROS:

Reactive oxygen species

VEGF:

Vascular endothelial growth factor

VSMC:

Vascular smooth muscle cell

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    Robert J. Tomanek

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Tomanek, R.J. (2013). Myocardial Ischemia and Infarction. In: Coronary Vasculature. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-4887-7_10

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