Ionic Mechanisms of Reperfusion Injury

  • Michael J. Shattock
Part of the Progress in Experimental Cardiology book series (PREC, volume 1)


Contractile and electrical dysfunction seen during early reperfusion can be attributed, to a large extent, to disturbances in ion regulation. Ion regulation is influenced primarily by three major sequalae of reperfusion: 1) the slow recovery of ATP, 2) the thermodynamic redistribution of ions down their electrochemical gradients, and 3) the direct damage induced to ion translocating proteins by the oxidant stress that accompanies the early minutes of reperfusion. All these processes combine to create the unfavorable conditions in which E-C coupling is compromised, leading to stunning and arrhythmias. Disturbances in Na ion distribution may be particularly important, since all three of the above sequalae profoundly affect Na transport. Firstly, the depletion of ATP during ischemia not only may limit Na-K ATPase activity on reperfusion but also may cause the Na-K pump protein to translocate away from the surface membrane. This outcome is likely to limit the ability of the cell to extrude Na during the critical early moments of reperfusion. This inability to extrude Na is then compounded by an increased influx of Na via the Na-H exchanger that occurs as the second sequalae of reperfusion comes into effect—the thermodynamic redistribution of ions. Finally, oxidant stress can inhibit the activity of the remaining Na-K pump by selectively oxidizing key thiol groups on the protein molecule. These metabolic, thermodynamic, and “dwect damage” effects of reperfusion thus combine to create Na and Ca overload, contractile dysfunction, and arrhythmias.


Sarcoplasmic Reticulum Myocardial Stunning Regional Washout Myocardial Contractile Depression 
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Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Michael J. Shattock
    • 1
  1. 1.The Rayne InstituteSt. Thomas’ HospitalUK

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