Summary
Ventricular arrhythmias which occur in the pre-hospital stage of a myocardial infarction constitute a major cause of death. Acute myocardial ischemia causes multiple electrophysiologic abnormalities which arise from a variety of factors such as extracellular K+ accumulation, increased membrane conductance to K+, intracellular acidosis, increased intracellular [Ca2+], catecholamine release, and accumulation of lysophospholipids and free fatty acid esters. There may be profound changes in all these factors during the first 10–15 min of myocardial ischemia and the arrhythmogenic potency of myocardial ischemia is related to the interplay of these multiple factors.
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References
Bersohn MM, Philipson KD, Fukushima JY (1982) Sodium—Calcium exchange and sarcolemmal enzymes in ischemic rabbit heart. American Journal of Physiology 242: C288 — C295
Chesnais JM, Corabouef E, Sauviat MP, Vassas JM (1975) Sensitivity to H, Li, and Mg ions of the slow inward current and sodium current in frog atrial fibers. Journal of Molecular and Cellular Cardiology 7: 627–642
Clarkson CW, Ten Eick RE (1983) On the mechanism of lysophosphatidyl choline-induced depolarization of cat ventricular myocardium. Circulation Research 52: 543–556
Colquhoun D, Neher E, Reuter H, Stevens CF (1981) Inward current channels activated by intracellular Ca in cultured cardiac cells. Nature 294: 752–754
Coronel R, Fiolet JW, Wilms-Schopman FJ, Schaapherder AF, Johnson TA, Gettes LS, Janse MJ (1988) Distribution of extracellular potassium and its relation to electrophysiologic changes during acute myocardial ischemia in the isolated perfused porcine heart. Circulation 77: 1125–1138
Corr PB, Gross RW, Sobel BE (1984) Amphipathic metabolites and membrane dysfunction in ischemic myocardium. Circulation Research 55: 135–153
Corr PB, Yamada KA, Creer MH, Sharma AD, Sobel BE (1987) Lysophosphoglycerides and ventricular fibrillation early after the onset of ischemia Journal of Molecular and Cellular Cardiology 19: 43–53
Cuevas J, Bassett AL, Cameron JS, Furukawa T, Myerburg RJ, Kimura S (1991) Effect of H+ on ATP-regulated K+ channels in feline ventricular myocytes. American Journal of Physiology 261: H755–761
Deutsch N, Klitzner TS, Lamp ST, Weiss JN (1991) Activation of cardiac ATP-sensitive K+ current during hypoxia: correlation with tissue ATP level. American Journal of Physiology 261: H671–676
Faivre J-F, Findlay I (1990) Action potential duration and activation of ATP-sensitive K+ channels in guinea-pig cardiac myocytes. Biochimica Biophysica Acta 1029: 167–172
Garan H, Fallon JT, Ruskin JN (1990) Sustained ventricular tachycardia in recent canine myocardial infarction. Circulation 62: 980–987
Gettes LS, Reuter H (1974) Slow recovery from inactivation of inward currents in mammalian myocardial fibers. Journal of Physiology 240: 703–724
Harris AS (1950) Delayed development of ventricular ectopic rhythms following experimental coronary occlusion. Circulation, 1: 1318–1328
Hill JL, Gettes LS (1980) Effect of acute coronary artery occlusion on local myocardial extracellular K+ activity in swine. Circulation 61: 768–778
Irasawa H, Sato R (1986) Intra-and extracellular effects of proton on the calcium current of isolated guinea pig ventricular cells. Circulation Research 59: 348–355
Janse MJ, Wit AL (1989) Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiological Reviews 69: 1049–1168
Kabell G, Brachmann J, Scherlan BJ, Harrison L, Lazzara R (1984) Mechanisms of ventricular arrhythmias in multi-vessel coronary disease: the effects of collateral zone ischemia. American Heart Journal 108: 447–454
Kaplinsky E, Ogawa S, Balke CW, Dreifus LS (1979) Two periods of early ventricular arrhythmias in the canine acute infarction model. Circulation 60: 397–403
Karaguezian HS, Fenoglio JJ, Weiss MB, Wit AL (1979) Protracted ventricular tachycardia induced by premature stimulation of the canine heart after coronary artery occlusion and reperfusion. Circulation Research 44: 833–846
Keung EC, Li Q (1991) Lactate activates ATP-sensitive K+ channels in guinea pig ventricular myocytes. Journal of Clinical Investigation 88: 1772–1777
Kirsch GE, Codina J, Birnaumer L, Brown AM (1990) Coupling of ATP-sensitive K + channels to Al receptors by G proteins in rat ventricular myocytes. American Journal of Physiology 259: H820–826
Kleber AG (1983) Resting membrane potential, extracellular potassium activity and intracellular sodium activity during acute global ischemia in isolated perfused guinea-pig hearts. Circulation Research 52: 442–450
Kleber AG (1984) Extracellular potassium accumulation in acute myocardial ischemia. Journal of Molecular and Cellular Cardiology. 16: 389–394
Kodama I, Wilde AAM, Janse MJ, Durrer D, Yamada K (1984) Combined effects of hypoxia, hyperkalemia, and acidosis on membrane action potential and excitability of guinea-pig ventricular muscle. Journal of Molecular and Cellular Cardiology 16: 248–256
Kuller L, Lilienfeld A, Fisher R (1966) Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease. Circulation 34: 1056–1068
Liberthson RR, Nagel EL, Hirschmann JC, Nussenfeld SR, Blackbourne BD, Davis JH (1974) Pathophysiologic observation in pre-hospital ventricular fibrillation and sudden cardiac death. Circulation 49: 790–798
Lederer WJ, Nichols CG (1989) Nucleotide modulation of the activity of rat heart ATP-sensitive K+ channels in isolated membrane patches. Journal of Physiology 419: 193–211
Marban E, Kitakaze M, Kusuoka H, Porterfield JK, Yue DT, Chacko VP (1987) Intracellular free calcium concentration measured with 19FNMR spectroscopy in intact ferret hearts. Proceedings of the National Academy of Sciences USA 84: 6005–6009
Mathur PP, Case RB (1973) Phosphate loss during reversible myocardial ischemia. Journal of Molecular and Cellular Cardiology 5: 375–393
Mohabir R, Lee HC, Kurz RW, Clusin WT (1991) Effects of ischemia and hypercarbic acidosis on myocyte calcium transients, contraction, and pH; in perfused rabbit hearts. Circulation Research 69: 1525–1537
Moreno H, Janse MN, Fiolet JWT, Krieger WJG, Crijns H, Durrer D (1980) Comparison of the effects of regional ischemia, hypoxia, hyperkalemia, and acidosis on intracellular and extracellular potentials and metabolism in the isolated porcine heart. Circulation Research 46: 634–646
Morley GE, Anumonwo JMB, Delmar M (1992) Effects of 2,4-dinitrophenol or low [ATP]; on cell excitability and action potential propagation in guinea pig ventricular myocytes. Circulation Research 71: 821–830
Nichols CG, Ripoll C, Lederer WJ (1991) ATP-sensitive potassium channel modulation of guinea pig ventricular action potential and contraction. Circulation Research 68: 280–287
Noma A (1983) ATP-regulated K+ channels in cardiac muscle. Nature 305: 147–148
Noma A, Tsuboi N (1987) Dependence of junctional conductance on proton, calcium and magnesium ions in cardiac paired cells of guinea-pig. Journal of Physiology 382: 193–211
Penny WJ (1983) The deleterious effects of myocardial catecholamines on cellular electrophysiology and arrhythmias during ischemia and reperfusion. Cardiovascular Research 17: 363–372
Pike MM, Kitakaze M, Marban E (1990) 23Na-NMR measurements of intracellular sodium in intact perfused ferret hearts during ischemia and reperfusion. American Journal of Physiology 259: H1767–1773, 1990
Riegger CB, Alperovich G, Kleber AG (1989) Effect of oxygen withdrawal on active and passive electrical properties of arterially perfused rabbit papillary muscle. Circulation Research 61: 271–279
Rovetto MJ, Whitmer JT, Neely JR (1973) Comparison of the effects of anoxia and whole heart ischemia on carbohydrate utilization in isolated working rat hearts. Circulation Research 32: 699–707
Saman S, Opie LH (1984) Mechanism of reduction of action potential duration of ventricular myocardium by exogenous lactate. Journal of Molecular Cellular Cardiology 16: 659–654
Sanguinetti MC, Scott AL, Zingaro GJ, Siegal PK (1988) BRL 34915 (cromakalim) activated ATP-sensitive K + channel in cardiac muscle. Proceeding of the National Academy of Sciences USA 85: 6954–6958
Sato R, Noma A, Kurachi Y, Irisawa H (1985) Effects of intracellular acidification on membrane currents in ventricular cells of the guinea pig. Circulation Research 57: 553–561
Schoemig A, Dart AM, Dietz R, Mayer E, Kuenler W (1984) Release of endogenous catecholamines in the ischemic myocardium of the cat. Part A: locally mediated release. Circulation Research 55: 689–701
Shine KI, Douglas AM, Ricchiuti NV (1977) Ischemia in isolated ventricular septa: mechanical events. American Journal of Physiology 232: H564–571, 1977
Steenbergen C, Murphy E, Levy L, London RE (1987) Elevation in cytosolic free calcium concentration early in myocardial ischemia in perfused rat heart. Circulation Research 60: 700–707
Venkatesh N, Stuart JS, Lamp ST, Alexander LD, Weiss JN (1992) Activation of ATP-sensitive K + channels by cromakalim. Effects on cellular K+ loss and cardiac function in ischemic and reperfused mammalian ventricle. Circulation Research 71: 1324–1333
Weiss JN (1991) Biochemical and metabolic aspects of arrhythmias. In: El-Sherif N, Samet P (eds) Cardiac Pacing and Electrophysiology, W.B. Saunders, Philadelphia, pp. 57–76
Weiss J, Hiltbrand B (1985) Functional compartmentation of glycolytic versus oxidative metabolism in isolated rabbit heart. Journal of Clinical Investigation 75: 436–447
Weiss JN, Lamp ST, Shine KI (1989) Cellular K+ loss and anion efflux during myocardial ischemia and metabolic inhibition. American Journal of Physiology 256: H1165–1173
Weiss JN, Shine KI (1982) Extracellular K+ accumulation during myocardial ischemia in isolated rabbit heart. American Journal of Physiology 242: H619–628
Weiss JN, Shine KI (1982) [K]0 accumulation and electrophysiologic alterations during early myocardial ischemia. American Journal of Physiology 243: H318–327
Weiss JN, Venkatesh N, Lamp ST (1992) ATP-sensitive K + channels and cellular K + loss in hypoxic and ischemic mammalian ventricle. Journal of Physiology 447: 649–673
Wit AL, Rosen MR (1986) Afterdepolarizations and triggered activity. In Fozzard HA, Haber E, Jennins RB, Katz AM, Morgan HE (eds) The Heart and Cardiovascular System: Scientific Foundations. Raven Press, New York, pp 1449–1490
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© 1994 Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt
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Deutsch, N., Weiss, J.N. (1994). Factors determining the arrhythmogenic potency of myocardial ischemia and time course of ischemia related arrhythmias. In: Zehender, M., Meinertz, T., Just, H. (eds) Myocardial Ischemia and Arrhythmia. Steinkopff. https://doi.org/10.1007/978-3-642-72505-0_10
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DOI: https://doi.org/10.1007/978-3-642-72505-0_10
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