Abstract
It is generally accepted that ischaemic injury to the myocardium arises from an imbalance between myocardial oxygen supply and demand. When ischaemia is brief, as is usually the case with stable angina, and there is already considerable narrowing in one or more of the coronary arteries, a relative decrease in reserve will manifest itself when demand is suddenly increased as a result of augmented work of the heart. When the decrease in oxygen supply is primary, when coronary flow decreases as a function of increased resistance in the coronary arterial and capillary system, the degree of ischaemia is often more severe. At other times this condition may be brief and transitory, with no residual damage.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Additional References
ANDERSON, J.L., MARSHALL, H.W., BRAY, B.E., LUTZ, J.R., FREDERICK, P.R., YANOWITZ, F.G., DATZ, F.L., KLAUSNER, S.C. and HAGAN, A.D. (1983). A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction. N. Engl J. Med., 308, 1312–1318.
BOUCEK, R.J. and MURPHY, W.P., Jr (1960). Segmental perfusion of the coronary arteries with fibrinolysis in man following acute myocardial infarction. Am. J. Cardiol., 6, 525–533 Eur Heart J., 4, Suppl. D, 73–78.
BRAUNWALD, E. and KLONER, R.A. (1982). The stunned myocardium: Prolonged, postischemic ventricular dysfunction. Circulation, 66, 1146–1149.
BUSSMANN, W.D., PASSEK, D., SEIDEL, W. and KALTENBACH, M. (1981). Reduction of CK and CK-MB indexes of infarct size by intravenous nitroglycerine. Circulation, 63, (3) 615;622.
CHATTERJEE, K. and PARMLEY, W.W. (1983). Vasodilator therapy for acute myocardial infarction and chronic congestive heart failure. J. Am. Coll. Cardiol., 1, 133–153.
COHN, J.N., FRANCIOSA, J.A., FRANCIS, G.S., ARCHIBALD, D., et al. (1981). Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure. Results of a Veterans Administration Cooperative Study. N. Eng. J. Med., 19, 1129–1135.
DE JONG, J.W., HARMSEN, E., DE TOMBE, P.P. and KEYZER, E. (1982). Nifedipine reduces adenine nucleotide breakdown in ischemic rat heart. Eur. J. Pharmacol., 81, 89–96.
DE JONG, J.W., HARMSEN, E., DE TOMBE, P.P. and KEYZER, E. (1983). Energy conservation in ischemic rat heart by nifedipine plus propranolol. Eur. Heart J., 4, Suppl C. 25–31.
DE WOOD, M.A., SPORES, J., NOTSKE, R., MOUSER, L.T., BURROUGHS, R., GOLDEN, M.S. and LANG, H.T. (1980). Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N. Eng. J. Med., 303, 897–902.
DURRER, J.D., LIE, K.I., VAN CAPELLE, J.L. and DURRER, D. (1981). Effect of sodium nitroprusside on mortality in acute myocardial infarction. N. Eng. J. Med., 304, 1121–1128.
FROHNER, K., KOHN, H., BIALONCYK, CH., UNGER, G., MEISL, F., PODCZECK, A., MOSTBECK, A. and STEINBACH, K. (1984). Beurteilung der System-
ischen Fibrinolysen Beim Acuten Myokardinfarkt mit Radionukleid Ventrikulographie und 201 Thallium Szintigraphie. Zeitschr. für Kardiol., 73, Suppl 1, 74.
GERSTENBLITH, G., OUYANG, P., ACHUFF, S.C., BULKLEY, B.H., BECKER, L.C., MELLITS, E.D. (and 6 OTHERS). (1982). Nifedipine in unstable angina: a double blind randomized trial. N. Eng. J. Med., 306, 885–894.
HARMSEN, E. (1984). Myocardial Purine Metabolism. Thesis. (Editor’s Note: No further details given).
HENNING, R.J., BECKER, H., VINCENT, J.L., THIJS, L., KALTER, E. and WEIL, M.H. (1981). Use of methylprenisolone in patients following acute myocardial infarction, hemodynamic and metabolic effects. Chest, 79, 186–194.
HJALMARSON, A., HERLITZ, J., HOLMBERG, S., RIJ’DEN, L., SWEDBERG, K., VEDIN, A. (and 6 OTHERS). (1983). The Goteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation, 67 (6,2), 126–132.
HOOGHOUDT, T.E.H., SERRUYS, P.W., REIBER, J.H.C., SLAGER, C.J., VAN DEN BRAND, M. and HUGENHOLTZ, P.G. (1982). The effect of recanalization of the occluded coronary artery in acute myocardial infarction on left ventricular function. Eur. Heart J., 3, 416–421.
HUGENHOLTZ, P.G., MICHELS, H.R., SERRUYS, P.W. and BROWER, R.W. (1981). Nifedipine in the treatment of unstable angina, coronary spasm and myocardial ischemia. Am. J. Cardiol., 47, 163–175.
HUGENHOLTZ, P.G. and SIMOONS, M.L. (1984). Thombolytic therapy for acute myocardial infarction, Hammersmith Cardiology Workshop Series, Raven Press 1, 175–184.
THE INTERNATIONAL COLLABORATIVE STUDY GROUP (1984). Reduction of infarct size with the early use of timolol in acute myocardial infarction, N. Eng. J. Med., 310, 9–15.
JAFFE, A.S., GELTMAN, E.M., TIEFENBRUNN, SA.J., AMBOS, H.D., STRAUSS, H.D., SOBEL, B.E. and ROBERTS, R. (1983). Reduction of infarct size in patients with inferior infarction with intravenous glyceryl trinitrate. A randomized study. Br. Heart J., 49, 452–460.
JENNINGS, R.B., GANTE, C.E. and REIMER, K.A. (1975). Ischemic Tissue Injury, Am. J. Pathol., 81, 179–198.
KENNEDY, J. W., RITCHIE, J.L., DAVIS, K.B. and FRITZ, J.K. (1983). Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial Infarction. N. Eng. J. Med., 309, 1477–1482.
LANGE, L.G. and SOBEL, B.E. (1982). Pharmacological salvage of myocardium A. Rev. Pharmac. Toxicol., 22, 115–143.
LEWIS, H.J.Jr, DAVIS, J.W., ARCHIBALD, D.G., STEINKE, W.E., SMITHERMAN, T.C., DOHERTY, J.E. (and 7 OTHERS). (1983). Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N. Eng. J. Med., 309, (7) 396–403.
MADIAS, J.E. and HOOD, W.B.Jr (1982). Effects of methyl-prenisolone on the ischemic damage in patients with acute myocardial infarction. Circulation, 65, 1106–1113.
MATHEY, D.G., RODEWALD, G., RENTROP, P. et al. (1981). Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: Complementary combined approach effecting reduced infarct size, preventing infarction, and improving left ventricular function. Am. Heart J., 102, 1194–1201.
MERX, W., DORR, R., RENTROP, P., BLANKE, H., KARSCH, K.R., MATHEY, D.G., KREMER, P., RUTSCH, W. and SCHMUTZLER, H. (1981). Evaluation of the effectiveness of intracoronary streptokinase infusion in acute myocardial infarction: Postprocedure management and hospital course in 204 patients. Am. Heart J., 102, 1181–1187.
MEYER, J., ERBEL, R. and SCHMITZ, H-J. (1984). Transluminale Angioplastik. Zeitschr. für Kardiol., 73, 73.
MULLER, J.E., MORRISON, J., STONE, P.H., RUDE, R.E., ROSNER, B., ROBERTS. R. (and 9 OTHERS). (1984a). Nifedipine therapy for patients with threatened and acute myocardial infarction a randomized double blind, placebo-controlled comparison. Circulation, 69,4, 740–747.
MULLER, J.E., TURI, G.T., PEARLE, D.L., SCHNEIDER, J.F., SERFAS, D.H., MORRISON, J. (and 9 OTHERS). (1984b). Nifedipine and conventional therapy for unstable angina pectoris: a randomized double blind comparison. Circulation, 69,4, 728–739.
NAYLER, W.G., FERRARI, R. and WILLIAMS, A. (1980). Protective effect of pretreatment with verapamil, nifedipine and propranolol on mitochondrial function in the ischernic and reperfused myocardium Am. J. Cardiol., 46, 242–248.
PARRATT, J.R. (1983). Pharmacological agents to aid the clinician in combatting myocardial ischemia. Eur. Heart J., 4, Suppl.D. 91–99.
RENTROP, P., BLANKE, H., KARSCH, K.R., RUTSCH, W., SCHARTL, M., MERX, W., DÖRR, R., MATHEY, D. and KUCK, K. (1981). Changes in left ventricular function after intracoronary streptokinase infusion in clinical evolving myocardial infarction. Am. Heart J., 102, 1188–1193.
RENTROP, P., BLANKE, H., KOSTERING, K. and KARSCH, K.R. (1979). Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase in combination with transluminal recanalization. Clin. Cardiol., 5, 354.
ROBERTS, R. (1983). Intravenous nitroglycerin in acute myocardial infarction. Am. J. Med., 74, (6b) 45–52. ROBERTS, R. and ISHIKAWA, Y. (1983). Enzymatic estimation of infarct size during reperfusion. Circulation, 68, (2,2) 183–189.
ROSS, J., THEROUX, P., SASAYMA, S., McKOWN, C. and FRANKLIN, D. (1975). Late recovery of cardiac function after coronary artery reperfusion. Circulation, 51, Suppl II, 21, abstract.
RUDE, R.E., MULLER, J.E. and BRAUNWALD, E. (1981). Efforts to limit the size of myocardial infarcts. Ann. intern. Med., 95, (6) 736–761.
SAXENA, P.R. (1983). Beta-adrenoceptor antagonists and blood flow to the jeopardized myocardium. Eur Heart J., 4, Suppl D, 101–108.
SCHAPER, W. (1983). Natural defense mechanisms to ischemia. Eur. Heart J., 4, Suppl. D. 73–78.
SERRUYS, P.W., BROWER, R.W., TEN KATEN, H.J. and MEESTER, G.T. (1980). Recovery from circulation depression after coronary artery bypass surgery. Eur. Surg. Res., 12, 369–382.
SERRUYS, P.W., VAN DEN BRAND, M., HOOGHOUDT, T.E.H., SIMOONS, M.L., FIORETTI, P., RUITER, J., FELS, F. and HUGENHOLTZ, P.G. (1982). Coronary recanalization in acute myocardial infarction: Immediate results and potential risks. Eur. Heart J., 3, 404–415.
SERRUYS, P.W., VAN DEN BRAND, M., BROWER, R.W. and HUGENHOLTZ, P.G. (1984). Left ventricular Hemodynamics, Regional Blood Flow, and Lactate Metabolism During Balloon Occlusion: Can We Alter the Sequence of Ischemic Events? In Silent Myocardial Ischemia. Rutishauser, W. and Roskamm, H. (eds) pp. 37–44, Berlin: Springer Verlag.
SHARMA, G.V.R.K., CELLA, G., PARISI, A.F. and SASAHARA, A.A. (1982). Thrombolytic Therapy. New Eng. J. Med., 306, 1268–1276.
SIMOONS, M.L., BALAKUMARAN, K., SERRUYS, P.W., VAN DEN BRAND, M., FIORETTI, P., REIBER, J.H.C., LIE, P. and HUGENHOLTZ, P.G. (1982). The effect of intracoronary thrombolysis with streptokinase on myocardial thallium redistribution and global and regional left ventricular function. Eur. Heart J., 2, 433–440.
VAN DER GIESSEN, W.J., MOOI, W., RUTTEN, A.M., VAN VLIET, H.H.D.M., SLAGER, C.J. and VERDOUW, P.D. (1983). A new model for coronary thrombosis in the pig; preliminary results with thrombolysis. Eur. Heart J., 4, Suppl C, 69–77.
VANHALEWEYK, G.L.J., SERRUYS, P.W. and HUGENHOLTZ, P.G. (1983). Antianginal electrophysiologic and hemodynamic effects of combined beta-blocker-calcium antagonist therapy. Eur. Heart J., 4, Suppl D, 117–128.
VERDOUW, P.D., HARTOG, J.M. and TEN CATE, F.J. (1981). Effects of nifedipine on the recovery of regional myocardial performance during reperfusion of ischemic myocardium. Prog. Pharmac., 4, (2) 91–100.
VERDOUW, P.D., WOLFFENBUTTEL, B.H.R. and TEN CATE, F.J. (1983). Nifedipine with and without propranolol in the treatment of myocardial ischemia. Effect on ventricular arrhythmias and recovery of regional wall function. Eur. Heart J., 4, Suppl B, (in press).
VÖHRINGER, H.F., LINDERER, T.H. and SCHRÖDER, R. (1984). Intravenöse Streptokinase Behandlung beim Acuten Myokardinfarkt: Langzeitverlauf. Zeitschr. für Kardiol., 73, 45.
ANAND, I.S., PHARMA, P.L., CHAKRAVARTI, R.N. and WAHI, P.L. (1980). Experimental myocardial infarction in rhesus monkeys. Verapamil pretreatment in the reduction of infarct size. Adv. Myocardiol., 2, 425–433.
CAIRNS, J.A. and KLASSEN, G.A. (1981). Intravenous propranolol therapy for acute myocardial infarction in man: hemodynamic and serial creatine kinase assessment. Chest, 79, (3) 227–285.
FIEDLER, V.B. (1981). Effects of molsidomine on coronary artery thrombosis and myocardial ischemia in acute canine experiments. Eur. J. Pharmac., 73, (1), 85–9.
JOHANNSSON, B.W. (1980). A comparative study of cardioselective beta-blockade and diazepam in patients with acute myocardial infarction and tachycardia. Acta med. scand., 207, (1–2), 47–53.
LIE, K.I. and FIOLET, J.W. (1983). Beta-blockade and acute myocardial infarction. Eur. Heart J., 4, Suppl D 167–171.
MELIN, J.A. and BECKER, L.C. (1983). Salvage of ischemic myocardium by prostacyclin during experimental myocardial infarction. J. Am. Coll. Cardiol., 2, (2) 279–286.
MULLER, J.E. and BRAUNWALD, E. (1983). Can Infarct size be limited in patients with acute myocardial infarction? Cardiovasc. Clin. 13, (1) 147–161.
OLSSON, G., REHNQVIST, N., LUNDMAN, T. and MELCHER, A. (1981). Metoprolol treatment after acute myocardial infarction. Effects on ventricular arrhythmias and exercise tests during 6 months. Acta med. scand., 210, (1–2), 59–65.
ROBERTS, R. (1983). Intravenous nitroglycerin in acute myocardial infarction. Am. J. Med., 74, (6b) 45–52.
ROGERS, G.G., ROSENDORFF, C., SHIMELL, C.J. and COULL, A. (1982). Effects of tiapamil on haemodynamics and myocardial salvage during myocardial infarction in the baboon. Cardiology, 69, (Suppl.) 58–67.
RUDE, R.E., MULLER, J.E. and BRAUNWALD, E. (1981). Efforts to limit the size of myocardial infarcts. Ann. intern. Med., 95, (6), 736–761.
SHEEHAN, F.H., MATHEY, D.G., SCHOFER, J., KREBBER, H.J. and DODGE, H.T. (1983). Effect of interventions in salvaging left ventricular function in acute myocardial infarction: a study of intracoronary streptokinase. Am. J. Cardiol., 52, (5) 431–438.
STACK, R.S., PHILLIPS, H.R. (3d), GRIERSON, D.S., BEHAR, V.S., KONG, Y., PETER, R.H., SWAIN, J.L. and GREENFIELD, J.C.Jr (1982). Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. J. clin. Invest., 72, (1) 84–95.
TONKIN, A.M., JOEL, S.E., REYNOLDS, J.L., AYLWARD, P.E., HEDDLE, W.F., McRITCHIE, R.J., WEST, M.J. and CHALMERS, J.P. (1981). Beta-blockade in acute myocardial infarction. Inability of relatively late administration to influence infarct size and arrhythmias. Med. J. Aust., 2, (3) 145–146.
YUSUF, S., RAMSDALE, D., PETO, R., FURSE, L., BENNETT, D., BRAY, C. and SLEIGHT, P. (1980). Early intravenous atenolol treatment in suspected acute myocardial infarction. Preliminary report of a randomized trial. Lancet, ii, (8189) 273–276.
Author information
Authors and Affiliations
Editor information
Copyright information
© 1984 Macmillan Publishers Limited
About this chapter
Cite this chapter
Hugenholtz, P.G., Deckers, J.W., van der Giessen, W.J., Serruys, P.S., Lubsen, J. (1984). Evidence for myocardial salvage in human clinical ischaemia. In: Paton, W., Mitchell, J., Turner, P., Padgham, C., Ashcroft, E. (eds) IUPHAR 9th International Congress of Pharmacology London 1984. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-17615-1_38
Download citation
DOI: https://doi.org/10.1007/978-1-349-17615-1_38
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-0-333-37136-7
Online ISBN: 978-1-349-17615-1
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)