Pathophysiology Of Severe Ischemic Myocardial Injury (developments In Cardiovascular Medicine)

In industrialized countries, ischemic heart disease is by far the most common organ-specific cause of death. The thrombotic occlusion of a coronary artery which had previously been severely altered by atherosclerosis, is the most frequent cause of ischemic deterioration of myocardial tissue, i. e. myocardial infarction. Death of the human individual occurs when myocardial ischemia causes a critical impairment of cardiac pump function. The failure of a heart with an ischemic area may be due to the amount and location of contractile tissue becoming paralyzed or even necrotic, or to arrhythmias provoked by the ischemic condition, or by a combination of both factors. Considerable progress has been made in the development of antiarrythmic therapy. Effective tools have been developed to reperfuse ischemic myocar­ dial tissue as soon as the patient reaches hospital. However, therapeutical principles for the ischemic-reperfused myocardium which would specifically interfere with the state of injury of the ischemic tissue at the onset of reperfusion, and avoid the apparent hazards of the reperfusion process itself, have yet to be established. But not only approved therapeutical concepts are lacking, the pathophysiology of myocardial cell injury in pro­ gressive ischemia and under reperfusion is in itself only partly understood. Front Matter....Pages i-xii Front Matter....Pages 1-1 Irreversible ischemic injury — definition of the problem....Pages 3-14 Recovery of severely ischemic myocardium — a challenge for the clinical cardiologist....Pages 15-24 Front Matter....Pages 25-25 The critical ATP threshold hypothesis....Pages 27-39 Importance of glycolytically produced ATP for the integrity of the threatened myocardial cell....Pages 41-65 Front Matter....Pages 67-67 Loss of sarcolemmal integrity in ischemic myocardium....Pages 69-89 Mitochondrial injury in the oxygen-depleted and reoxygenated myocardial cell....Pages 91-113 Lysosomal integrity in ischemic, hypoxic and recovering heart....Pages 115-145 Front Matter....Pages 147-147 Detrimental effects of fatty acids and their derivatives in ischemic and reperfused myocardium....Pages 149-166 Hydrolysis of phospholipids and cellular integrity....Pages 167-193 Eicosanoids and the ischemic myocardium....Pages 195-217 Front Matter....Pages 219-219 Importance of free radicals generated by endothelial and myocardial cells in ischemia and reperfusion....Pages 221-238 The role of leukocytes in ischemic damage, reperfusion injury and repair of the myocardium....Pages 239-267 Problems associated with reperfusion of ischemic myocardium....Pages 269-280 Front Matter....Pages 281-281 Subcellular calcium shifts in ischemia and reperfusion....Pages 283-296 Causes and effects of changes in cytosolic free calcium in the hypoxic myocardial cell....Pages 297-314 Front Matter....Pages 315-315 Rigor and contracture: the role of phosphorus compounds and cytosolic Ca 2+ ....Pages 317-336 Importance of mechanical factors in ischemic and reperfusion injury....Pages 337-355 Front Matter....Pages 357-357 Sensitivity of the endothelium to hypoxia and reoxygenation....Pages 359-379 Release and effects of catecholamines in myocardial ischemia....Pages 381-412 Front Matter....Pages 413-413 Severe ischemic myocardial injury: Perspectives for therapy....Pages 415-422 Back Matter....Pages 423-428 Edited By Hans Michael Piper. Includes Index. Includes Bibliographical References.