Document Detail

Dynamic vascular factors in the genesis of myocardial ischemia.
MedLine Citation:
PMID:  6219154     Owner:  NLM     Status:  MEDLINE    
While fixed atherosclerotic and thrombotic lesions have long been known to cause myocardial ischemia and cardiac pain, the various transient or dynamic events that may also cause ischemia and pain have become better understood in the past 15 years. These can be classified into two broad categories: those that cause a dynamic reduction in the caliber of the coronary arteries and those that reduce the coronary vasodilatory reserve capacity. In the first group are myocardial compression or "bridging" of an artery; coronary vasoconstriction due to frank spasm or generalized arterial hypertonus, particularly at the site of atherosclerotic lesions; reduced arterial distending pressure and platelet aggregation which may transiently occlude a diseased arterial segment. The causes of inadequate coronary vascular reserve flow capacity can be either anatomic or functional. Among the former, the increased muscle mass to blood vessel ratio occurring in myocardial hypertrophy is most important. The functional causes of limited coronary vascular reserve include diastolic transmural compression and coronary "steal," both of hemodynamic origin. In addition, arteriolar "unresponsiveness" or dysregulation caused by smoking, drugs or other unknown conditions may adversely affect coronary vascular reserve. Hence, myocardial ischemia may result from conditions that limit potential for increase in flow or from conditions that reduce flow from a preexisting level. These conditions, which are transient and dynamic in nature, may modify the threshold for ischemia, particularly in patients with fixed coronary obstructive disease.
R Gorlin
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  1     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1983 Mar 
Date Detail:
Created Date:  1983-04-07     Completed Date:  1983-04-07     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  897-906     Citation Subset:  IM    
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MeSH Terms
Angina Pectoris / physiopathology
Blood Pressure
Cardiomegaly / physiopathology
Coronary Circulation*
Coronary Disease / blood,  etiology,  physiopathology*
Ischemic Attack, Transient / pathology,  physiopathology
Lactates / metabolism
Myocardium / metabolism
Physical Exertion
Platelet Aggregation
Vascular Diseases / classification
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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