Skip to main content
SpringerLink
Log in

Pathogenesis and Pathology of Ischemic Heart Disease Syndromes

  • Chapter
Book cover Coronary Care Medicine

  • 91 Accesses

Abstract

The terms “arteriosclerosis” and “athero sclerosis”are often confused in descriptions of experimental and clinical arterial lesions. Arteriosclerosis is a general term implying arterial hardening without respect to a specific etiology, examples being atherosclerosis, Mönckeberg’s medial calcification, and arteriolosclerosis (small vessel disease) [1]. Atherosclerosis refers to a specific disease process characterized by the development of yellow, lipid-laden plaques. There are three pathological stages in such plaque development:

  1. 1.

    The fatty streak, which is a yellow, generally flat patch on the intima made up of accumulated lipid-containing smooth muscle cells. Commonly found in young individuals fatty streaks probably have no pathological significance in many cases.

  2. 2.

    The fibrous plaque, which is an intimai deposit of lipid-laden smooth muscle cells surrounded by collagen, elastic fibers, and extracellular lipid. Fibrous plaques may or may not arise from fatty streaks and can exist without causing significant obstruction of the vascular lumen.

  3. 3.

    The complex plaque, which is a fibrous plaque that has progressed to include calcification, hemorrhage, cell necrosis, an inflammatory reaction, and extension to the arterial media. Adventitial fibrosis and inflammation may be present.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Wissler RW: Principles of the pathogenesis of atherosclerosis. In: Heart disease: a textbook of cardiovascular medicine, Braunwald E (ed). Philadelphia, WB Saunders Company, 1984, pp 1183–1204.

    Google Scholar 

  2. McCullagh KG: Revised concepts of athero-genesis: a review. Cleveland Clin Quart 43: 248–266, 1976.

    Google Scholar 

  3. Ross R. Glomset JA: The pathogenesis of atherosclerosis. Part 1. N Engl J Med 295: 369–377, 1976.

    Article  PubMed  CAS  Google Scholar 

  4. Ross R. Glomset JA: The pathogenesis of atherosclerosis. Part 2. N Engl J Med 295: 420–425, 1976.

    Article  PubMed  CAS  Google Scholar 

  5. Weisman HF, Bulkley BH: Pathophysiology of atherosclerotic heart disease. Cardiol Clin 2: 555–569, 1984.

    PubMed  CAS  Google Scholar 

  6. Benditt EP, Benditt JM: Evidence for a monoclonal origin of human atherosclerotic plaques. Proc Natl Acad Sci (USA) 70: 1753–1756, 1973.

    Article  CAS  Google Scholar 

  7. Ross R: Atherosclerosis: a problem of the biology of arterial wall cells and their interactions with blood components. Arteriosclerosis 1: 293–311, 1981.

    Article  PubMed  CAS  Google Scholar 

  8. Steinberg D: Lipoproteins and atherosclerosis. A look back and a look ahead. Arteriosclerosis 3: 283–301, 1983.

    Article  PubMed  CAS  Google Scholar 

  9. Furchgott RF: Role of endothelium in responses of vascular smooth muscle. Circ Res 53: 557–573, 1983.

    PubMed  CAS  Google Scholar 

  10. Barger AC, Beeuwkes B, Lainey LL, Silverman KJ: Hypothesis: vasa vasorum and neovascular-ization of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N Engl J Med 310: 175–177, 1984.

    Article  PubMed  CAS  Google Scholar 

  11. Braunwald E, Sobel BE: Coronary blood flow and myocardial ischemia. In: Heart disease: a textbook of cardiovascular medicine, 2nd ed, Braunwald E (ed). Philadelphia, WB Saunders Company, 1984, pp 1235–1261.

    Google Scholar 

  12. Pooling Project Research Group: Relation of blood pressure, serum cholesterol, smoking habits, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project. J Chron Dis 31: 201–306, 1978.

    Article  Google Scholar 

  13. The Lipid Research Clinics Population Studies Data Book, Vol 1, The Prevalence Study. Lipid Metabolism Branch, Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute. US Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publ No 80-1527, Government Printing Office, July, 1980.

    Google Scholar 

  14. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. Lipid Research Clinics (LRC) Program. Lipid Metabolism-Atherogenesis Branch, National Heart, Lung, and Blood Institute. JAMA 251: 351, 1984.

    Article  Google Scholar 

  15. The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction of incidence of coronary heart disease to cholesterol lowering. Lipid Research Clinics (LRC) Program. Lipid Metabolism-Athero-genesis Branch, National Heart, Lung, and Blood Institute. JAMA 251: 365, 1984.

    Article  Google Scholar 

  16. Hulley SB, Rosenman RH, Bawol RD, et al: Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease. N Engl J Med 302: 1383–1389, 1980.

    Article  PubMed  CAS  Google Scholar 

  17. Campeau L, Enjalbert M, Lesperance J, Bourassa MG, Kwiterovich P Jr, Wacholder S, Sniderman A: The relation of risk factors to the development of atherosclerosis in saphenous-vein bypass grafts and the progression of disease in the native circulation: A study 10 years after aortocoronary bypass surgery. N Engl J Med 311: 1329–1332, 1984.

    Article  PubMed  CAS  Google Scholar 

  18. Castelli WP, Doyle JT, Gordon T, Haines CG, Hjortland M, Hulley SB, Kagan A, Zukel WJ: HDL cholesterol and other lipids in coronary heart disease. The Cooperative Lipoprotein Phenotyping Study. Circulation 55: 767, 1977.

    PubMed  CAS  Google Scholar 

  19. Ryder REJ, Hayes TM, Mulligan IP, Kingswood JC, Williams S, Owens DR: How soon after myocardial infarction should plasma lipid values be assessed? Br Med J 289: 1651–1653, 1984.

    Article  CAS  Google Scholar 

  20. Kannel WB: Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol 37: 269–282, 1976.

    Article  PubMed  CAS  Google Scholar 

  21. Chobanian AV: Treatment of mild hypertension — the debate intensifies. J Cardiovasc Med August, 1983, p 883.

    Google Scholar 

  22. The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 144: 1045–1057, 1984.

    Article  Google Scholar 

  23. Fuchs R, Scheidt SS: Prevention of coronary atherosclerosis. Part I. Cardiovasc Rev Rep 4: 671–695, 1983.

    Google Scholar 

  24. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. I. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 202: 1028–1034, 1967.

    Article  Google Scholar 

  25. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressures averaging 90 through 114 mm Hg. JAMA 213: 1143–1152, 1970.

    Article  Google Scholar 

  26. Berglund G, Sannerstedt R, Anderson O, et al: Coronary heart disease after treatment of hypertension. Lancet 1: 1–5, 1978.

    Article  PubMed  CAS  Google Scholar 

  27. Management Committee of the Australian Hypertension Trial: The Australian Therapeutic Trial in mild hypertension. Lancet 1: 1261–1269, 1980.

    Google Scholar 

  28. Hypertension Detection and Follow-Up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-Up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 242: 2562–2571, 1979.

    Article  Google Scholar 

  29. Hypertension Detection and Follow-Up Program Cooperative Group: The effect of treatment on mortality in “mild” hypertension. Results of the Hypertension Detection and Follow-Up Program. N Engl J Med 307: 976–980, 1982.

    Article  Google Scholar 

  30. Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. JAMA 248: 1466–1477, 1982.

    Google Scholar 

  31. Beta-Blocker Heart Attack Trial Research Group: A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 247: 1707–1714, 1982.

    Article  Google Scholar 

  32. Norwegian Multicentre Study Group: Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–807, 1981.

    Article  Google Scholar 

  33. Hjalmarson A, Herlitz J, Malek I, et al: Effect on mortality of metoprolol in acute myocardial infarction: a double-blind randomized trial. Lancet 2: 823–827, 1981.

    Article  PubMed  CAS  Google Scholar 

  34. Kannel WB, Doyle JT, Frednckson DT, Harland WR: Report of the Ad Hoc Committee on Cigarette Smoking and Cardiovascular Diseases for Health Professionals. Circulation 57: 406A, 1978.

    PubMed  CAS  Google Scholar 

  35. Mulcahy R: Influence of cigarette smoking on morbidity and mortality after myocardial infarction. Br Heart J 49: 410–415, 1983.

    Article  PubMed  CAS  Google Scholar 

  36. Daly, LE, Mulcahy R, et al: Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction. Br Med J 287: 324–526, 1983.

    Article  CAS  Google Scholar 

  37. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR: Diabetes, blood lipids and the role of obesity in coronary heart disease risk for women. The Framingham Study. Ann Intern Med 87: 393, 1977.

    PubMed  CAS  Google Scholar 

  38. Shurtleff D: Some characteristics related to the incidence of cardiovascular disease and death: The Framingham Study, 18-year follow-up. Washington, DC, DHEW Publ No (NIH) 74–599, Section No 30, 1974.

    Google Scholar 

  39. Fuchs R, Scheidt S: Prevention of coronary atherosclerosis. Part II. Cardiovasc Rev Rep 4: 791–812, 1983.

    Google Scholar 

  40. University Group Diabetes Program. II. Mortality results. Diabetes 19(Suppl. 2): 785, 1970.

    Google Scholar 

  41. Knatterud GL, Klimt CR, Levin ME, Jacobson ME, Goldner MG: Effects of hypoglycemic agents in vascular complications in patients with adult-onset diabetes. VII. Mortality and selected nonfatal events with insulin treatment. JAMA 240: 37, 1978.

    Article  PubMed  CAS  Google Scholar 

  42. Roberts WC, Buja LM: The frequency and significance of coronary arterial thrombi and other observations in fatal acute myocardial infarction: a study of 107 necropsy patients. Am J Med 52: 425, 1972.

    Article  PubMed  CAS  Google Scholar 

  43. Likoff W: Myocardial infarction in subjects with normal coronary arteriograms. Am J Cardiol 28: 742, 1971.

    Article  PubMed  CAS  Google Scholar 

  44. Jennings RB, Ganote CE, Reimer KA: Ischemic tissue injury. Am J Pathol 81: 179–198, 1975.

    PubMed  CAS  Google Scholar 

  45. Reimer KA, Jennings RB, Tatum AH: Patho-biology of acute myocardial ischemia: metabolic, functional and ultrastructural studies. Am J Cardiol 52: 72A–81A, 1983.

    Article  PubMed  CAS  Google Scholar 

  46. Jennings RB, Reimer KA, Hill ML, Mayer SE: Total ischemia in dog hearts, in vitro. 1. Comparison of high energy phosphate production, utilization, and depletion and of adenine nu-cleotide catabolism in total ischemia in vitro vs severe ischemia in vivo. Circ Res 49: 892–900, 1981.

    PubMed  CAS  Google Scholar 

  47. Reimer KA, Jennings RB, Hill ML: Total ischemia in dog hearts, in vitro. 2. High energy phosphate depletion and associated defects in energy metabolism, cell volume regulation, and sarcolemmal integrity. Circ Res 49: 901–911, 1981.

    PubMed  CAS  Google Scholar 

  48. Jennings RB, Reimer KA: Factors involved in salvaging Ischemic myocardium: effect of re-perfusion of arterial blood. Circulation 68: 125–136, 1983.

    Google Scholar 

  49. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB: The wavefront phenomenon of Ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 56: 786–794, 1977.

    PubMed  CAS  Google Scholar 

  50. 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 Invest 40: 633–644, 1979.

    PubMed  CAS  Google Scholar 

  51. Jugdutt BI, Hutchins GM, Bulkley BH, Becker LC: Myocardial infarction in the conscious dog: three-dimensional mapping of the infarct, collateral flow and region at risk. Circulation 60: 1141–1150, 1979.

    PubMed  CAS  Google Scholar 

  52. Alpert JS, Braunwald E: Acute myocardial infarction: pathological, pathophysiological, and clinical manifestations. In: Heart disease: a textbook of cardiovascular medicine, 2nd ed, Braunwald E (ed). Philadelphia, WB, Saunders Company, 1984, pp 1262–1300.

    Google Scholar 

  53. Willerson JT, Hillis LD, Buja LM: Pathogenesis and pathology of Ischemic heart disease. In: Ischemic heart disease: clinical and pathophysiological aspects. Braunwald E (ed). New York, Raven Press, 1982, pp 7–83.

    Google Scholar 

  54. Buja LM, Willerson JT: Clinicopathologic correlates of acute Ischemic heart disease syndromes. Am J Cardiol 47: 343–356, 1981.

    Article  PubMed  CAS  Google Scholar 

  55. Salimi A, Oliver GC Jr, Lee J, Sherman LA: Continued incorporation of circulating radio-labeled fibrinogen into preformed coronary artery thrombi. Circulation 56: 213–217, 1977.

    PubMed  CAS  Google Scholar 

  56. Fulton WFM, Summer DJ: Causal role of coronary thrombotic occlusion in myocardial infarction: evidence of stereo-arteriography serial sections and autoradiography (Abstr.). Am J Cardiol 39: 322, 1977.

    Google Scholar 

  57. Oliva PB, Breckenridge JC: Arteriographie evidence of coronary arterial spasm in acute myocardial infarction. Circulation 56: 366–374, 1977.

    PubMed  CAS  Google Scholar 

  58. DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT: Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N. Engl J Med 303: 897–902, 1980.

    Article  Google Scholar 

  59. Epstein SE, Palmeri ST: Mechanisms contributing to precipitation of unstable angina and acute myocardial infarction: implications regarding therapy. Am J Cardiol 54: 1245–1252, 1984.

    Article  PubMed  CAS  Google Scholar 

  60. Lawrence JR, Shepherd JT, Bone I, Rogen AS, Fulton WFM: Fibrinolytic therapy in unstable angina pectoris: a controlled clinical trial. Thromb Res 17: 767–777, 1980.

    Article  PubMed  CAS  Google Scholar 

  61. Telford AM, Wilson C: Trial of heparin vs atenolol in prevention of myocardial infarction in intermediate coronary syndrome. Lancet 1: 1225–1228, 1981.

    Article  PubMed  CAS  Google Scholar 

  62. Thomas AC, Davies MJ, Popple AW: A patho-logist’s view of sudden cardiac death. In: Sudden Death, Kulbertus HE, Wellens HJ (eds). The Hague, Martinus Nijhoff, 1980, pp 34–48.

    Google Scholar 

  63. Davies MJ, Thomas A: Thrombosis and acute coronary-artery lesions in sudden cardiac Ischemic death. N Engl J Med 310: 1137–1140, 1984.

    Article  PubMed  CAS  Google Scholar 

  64. Lewis HD Jr, Davis JW, Archibald DG, et al: Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of Veterans Administration Cooperative Study. N Engl J Med 309: 396–403, 1983.

    Article  PubMed  Google Scholar 

  65. Mustard JF, Kinlough-Rathbone RL, Packham MA: Aspirin in the treatment of cardiovascular disease: a review. Am J Med 74: 43–49 (Aspirin Symposium Supplement), 1983.

    Article  PubMed  CAS  Google Scholar 

  66. May GS, Eberlein KA, Furberg CD, Passamani ER, DeMets DL: Secondary prevention after myocardial infarction: a review of long term trials. Progr Cardiovasc Dis 24: 331–352, 1982.

    Article  CAS  Google Scholar 

  67. Hillis LD, Cohn PF: Nonatherosclerotic coronary artery disease. In: Diagnosis and therapy of coronary artery disease, Cohn PF (ed). Boston, Little Brown and Co, 1979, p 481.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA

    Elliott M. Antman M.D., F.A.C.C (Assistant Professor of Medicine Harvard Medical School, Director Samuel A. Levine Cardiac Unit) & John D. Rutherford M.B., F.R.A.C.P., F.A.C.C (Assistant Professor of Medicine Harvard Medical School Co-Director, Clinical Cardiology Service)

  2. Cardiologist, Green Lane Hospital, Auckland, New Zealand

    John D. Rutherford M.B., F.R.A.C.P., F.A.C.C (Assistant Professor of Medicine Harvard Medical School Co-Director, Clinical Cardiology Service)

Authors
  1. Elliott M. Antman M.D., F.A.C.C
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John D. Rutherford M.B., F.R.A.C.P., F.A.C.C
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1986 Martinus Nijhoff Publishing, Boston.

About this chapter

Cite this chapter

Antman, E.M., Rutherford, J.D. (1986). Pathogenesis and Pathology of Ischemic Heart Disease Syndromes. In: Coronary Care Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2303-7_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-2303-7_1

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9418-4

  • Online ISBN: 978-1-4613-2303-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation