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Ventricular Repolarization in Myocardial Ischemia and Myocardial Infarction:Theory and Practice

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Comprehensive Electrocardiology

1 18.1 Physiologic and Biochemical Processes Responsible for the ElectrocardiographicAlterations During Myocardial Ischemia and Myocardial Infarction

The dominant effects of ischemia during the first few minutes are cellular K+ loss, extracellular K+ accumulation, and acidosis, resulting in rapid depolarization, inexcitability, and loss of active tension development. After a latency period of several minutes, there is a second phase of K+ loss, increase in free cytosolic Ca2 +, electrical cell-to-cell uncoupling, and development of ischemic contracture [1].

Normally, the cell maintains a balance between influx and efflux of K+. The influx occurs mainly through the Na+ ∕ K+ pump that has been assumed to function normally within the first 10–15 min of ischemia [2, 3]. Thus, the increase in extracellular K+ must be attributed to an increased K+ efflux taking place passively as a consequence of the K concentration gradient and through gated K+ channels. One of the suggested causes of K+...

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Notes

  1. 1.

    ∗Current nomenclature; non-ST elevation myocardial infarction (NSTEMI)

  2. 2.

    ∗ ∗Previously known as acute Q-wave MI

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Authors and Affiliations

  1. The Care Group at St Vincent Hospital, Indianapolis, IN, USA

    Borys Surawicz

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  1. Borys Surawicz
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Editors and Affiliations

  1. University of Glasgow, Glasgow, UK

    Peter W. Macfarlane

  2. Radboud University Nijmegen, Nijmegen, The Netherlands

    A. van Oosterom

  3. Lund University, Lund, Sweden

    Olle Pahlm

  4. Weill Cornell Medical College, New York, NY, USA

    Paul Kligfield

  5. University of Amsterdam, Amsterdam, The Netherlands

    Michiel Janse

  6. St. George's, University of London, London, UK

    John Camm

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Surawicz, B. (2010). Ventricular Repolarization in Myocardial Ischemia and Myocardial Infarction:Theory and Practice. In: Macfarlane, P.W., van Oosterom, A., Pahlm, O., Kligfield, P., Janse, M., Camm, J. (eds) Comprehensive Electrocardiology. Springer, London. https://doi.org/10.1007/978-1-84882-046-3_18

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