Lack of Coronary Blood Flow or Myocardial Oxygen Supply/Demand Imbalance?
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Regional myocardial blood flow and contractile function in ischemic myocardium are well matched, and there is no evidence for an oxygen supply/demand imbalance. Thus, myocardial ischemia is lack of coronary blood flow with electric, functional, metabolic, and structural consequences for the myocardium. All therapeutic interventions must aim to improve blood flow to ischemic myocardium as much and as quickly as possible.
Virchow in 1858 originally coined the term “ischemia” (ἰσχαιμία=withholding of blood) to characterize the reduction of blood flow to an organ or tissue and its consequences,1 and Cohnheim in 1881 first performed coronary artery ligation in dogs to demonstrate that myocardial infarction results from coronary obstruction.2 Rein and Büchner in the 30s of the last century performed experiments to show that coronary blood flow was closely related to myocardial function and that myocardial necrosis could be induced by a combination of reduced oxygen supply (hypoxia or anemia) with exercise; they suggested that the relation of coronary blood flow to myocardial function is the criterion for sufficiency or insufficiency of coronary blood flow and that coronary insufficiency resulted in myocardial necrosis and fibrosis.3 In the 1950s and 1960s of the last century, Braunwald et al4 worked out the hemodynamic determinants of myocardial oxygen consumption.5 In the 1970s of the last century, they showed in a series of dog experiments that interventions which increased the hemodynamic determinants of myocardial oxygen consumption, notably catecholamines, increased infarct …