Ischaemic Heart Disease

  • Katarzyna MichaudEmail author


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.


Ischaemic heart disease Coronary thrombosis Sudden cardiac death Coronary plaque Myocardial infarct Plaque disruption Stunned myocardium 


  1. 1.
    Townsend N, et al. Cardiovascular disease in Europe – epidemiological update 2015. Eur Heart J. 2015;36(40):2696–705.PubMedCrossRefGoogle Scholar
  2. 2.
    Hayashi M, Shimizu W, Albert CM. The spectrum of epidemiology underlying sudden cardiac death. Circ Res. 2015;116(12):1887–906.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Shah PK. Screening asymptomatic subjects for subclinical atherosclerosis: can we, does it matter, and should we? J Am Coll Cardiol. 2010;56(2):98–105.PubMedCrossRefGoogle Scholar
  4. 4.
    Thygesen K, et al. Fourth universal definition of myocardial infarction. Eur Heart J. 2018;2018:ehy462.Google Scholar
  5. 5.
    Yusuf S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Thiene G, Basso C. Myocardial infarction: a paradigm of success in modern medicine. Cardiovasc Pathol. 2010;19(1):1–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Falk E. Pathogenesis of atherosclerosis. J Am Coll Cardiol. 2006;47(8 Suppl):C7–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Ross R, Glomset JA. The pathogenesis of atherosclerosis (first of two parts). N Engl J Med. 1976;295(7):369–77.PubMedCrossRefGoogle Scholar
  10. 10.
    Moreno PR. Vulnerable plaque: definition, diagnosis, and treatment. Cardiol Clin. 2010;28(1):1–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Finn AV, et al. Concept of vulnerable/unstable plaque. Arterioscler Thromb Vasc Biol. 2010;30(7):1282–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Packard RR, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem. 2008;54(1):24–38.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Sanz J, Moreno PR, Fuster V. The year in atherothrombosis. J Am Coll Cardiol. 2010;55(14):1487–98.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Moreno PR, Sanz J, Fuster V. Promoting mechanisms of vascular health: circulating progenitor cells, angiogenesis, and reverse cholesterol transport. J Am Coll Cardiol. 2009;53(25):2315–23.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Glagov S, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316(22):1371–5.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Schoenhagen P, et al. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes : an intravascular ultrasound study. Circulation. 2000;101(6):598–603.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Ambrose JA, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol. 1988;12(1):56–62.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Burke AP, et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997;336(18):1276–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Davies MJ. Coronary disease—the pathophysiology of acute coronary syndromes. Heart. 2000;83(3):361–6.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Virmani R, et al. Vulnerable plaque: the pathology of unstable coronary lesions. J Interv Cardiol. 2002;15(6):439–46.PubMedCrossRefGoogle Scholar
  21. 21.
    Sheppard M, Davies MJ. In: Arnold H, editor. Practical cardiovascular pathology. London: Oxford University Press; 2011.CrossRefGoogle Scholar
  22. 22.
    Libby P. Act local, act global: inflammation and the multiplicity of “vulnerable” coronary plaques. J Am Coll Cardiol. 2005;45(10):1600–2.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Virmani R, et al. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47(8 Suppl):C13–8.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, Part I. Mayo Clin Proc. 2009;84(10):917–38.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part II. Mayo Clin Proc. 2009;84(11):1021–36.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    White HD, Chew DP. Acute myocardial infarction. Lancet. 2008;372(9638):570–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Basso C, Rizzo S, Thiene G. The metamorphosis of myocardial infarction following coronary recanalization. Cardiovasc Pathol. 2010;19(1):22–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Reimer KA, Jennings RB. The “wavefront phenomenon” of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Lab Investig. 1979;40(6):633–44.PubMedGoogle Scholar
  29. 29.
    Basso C, Thiene G. The pathophysiology of myocardial reperfusion: a pathologist’s perspective. Heart. 2006;92(11):1559–62.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    van der Wal AC. Coronary artery pathology. Heart. 2007;93(11):1484–9.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Kramer MC, et al. Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. J Am Coll Cardiol. 2010;55(2):122–32.PubMedCrossRefGoogle Scholar
  32. 32.
    Fujino A, et al. Atherosclerotic plaque component as a risk factor for distal embolization during percutaneous coronary intervention – pathology of tissue obtained by distal protection device. Circ J. 2018;82(9):2292–8.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Buja LM. Myocardial ischemia and reperfusion injury. Cardiovasc Pathol. 2005;14(4):170–5.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Fineschi V, Baroldi G, Silver MD. Pathology of the heart and sudden death in forensic medicine. London: CRC Press Taylor & Francis Group, LCC; 2006.CrossRefGoogle Scholar
  35. 35.
    Campobasso CP, et al. Sudden cardiac death and myocardial ischemia indicators: a comparative study of four immunohistochemical markers. Am J Forensic Med Pathol. 2008;29(2):154–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Ortmann C, Pfeiffer H, Brinkmann B. A comparative study on the immunohistochemical detection of early myocardial damage. Int J Legal Med. 2000;113(4):215–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Aljakna A, Fracasso T, Sabatasso S. Molecular tissue changes in early myocardial ischemia: from pathophysiology to the identification of new diagnostic markers. Int J Legal Med. 2018;132(2):425–38.PubMedCrossRefGoogle Scholar
  38. 38.
    Sabatasso S, et al. Early markers for myocardial ischemia and sudden cardiac death. Int J Legal Med. 2016;130(5):1265–80.PubMedCrossRefGoogle Scholar
  39. 39.
    Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications – part 2. Circulation. 2001;104(25):3158–67.PubMedCrossRefGoogle Scholar
  40. 40.
    Kloner RA, Jennings RB. Consequences of brief ischemia: Stunning, preconditioning, and their clinical implications – part 1. Circulation. 2001;104(24):2981–9.PubMedCrossRefGoogle Scholar
  41. 41.
    De Meyer GR, De Keulenaer GW, Martinet W. Role of autophagy in heart failure associated with aging. Heart Fail Rev. 2010;15(5):423–30.PubMedCrossRefGoogle Scholar
  42. 42.
    Kunapuli S, Rosanio S, Schwarz ER. “How do cardiomyocytes die?” Apoptosis and autophagic cell death in cardiac myocytes. J Card Fail. 2006;12(5):381–91.PubMedCrossRefGoogle Scholar
  43. 43.
    Slezak J, et al. Hibernating myocardium: pathophysiology, diagnosis and treatment. Can J Physiol Pharmacol. 2009;87:252–65.PubMedCrossRefGoogle Scholar
  44. 44.
    Hunt SA, et al. focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391–479.PubMedGoogle Scholar
  45. 45.
    Gheorghiade M, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–68.PubMedCrossRefGoogle Scholar
  46. 46.
    Pang PS, Komajda M, Gheorghiade M. The current and future management of acute heart failure syndromes. Eur Heart J. 2010;31(7):784–93.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Becker AE, van Mantgem JP. Cardiac tamponade. A study of 50 hearts. Eur J Cardiol. 1975;3(4):349–58.PubMedGoogle Scholar
  48. 48.
    Goldstein JA. Pathophysiology and management of right heart ischemia. J Am Coll Cardiol. 2002;40(5):841–53.PubMedCrossRefGoogle Scholar
  49. 49.
    Rambihar S, Dokainish H. Right ventricular involvement in patients with coronary artery disease. Curr Opin Cardiol. 2010;25(5):456–63.PubMedCrossRefGoogle Scholar
  50. 50.
    Alegria JR, et al. Myocardial bridging. Eur Heart J. 2005;26(12):1159–68.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of LausanneLausanneSwitzerland

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