Document Detail


Hibernating myocardium, stunning, ischemic preconditioning: clinical relevance.
MedLine Citation:
PMID:  11072559     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hibernation is a chronic condition that can be due to either chronic low perfusion or repetitive stunning. When oxygen demands increase, prolonged periods of ischemia occur, resulting in multiple episodes of stunning. Because hibernation may play a significant role in refractory failure, the diagnosis of hibernation followed by reperfusion can be life saving. Myocardium that has sustained a transient sublethal injury but has the potential for recovery with time is referred to as stunned myocardium. Myocardial stunning is commonly seen after coronary artery bypass surgery: variable periods of myocardial ischemia are sustained during coronary artery bypass graft surgery, and when these patients return to the intensive care unit, their ventricular function is severely impaired because of the prolonged anoxia during bypass. With the support of artificial assist devices, counterpulsation or temporary use of catecholamines, these patients improve and have a favorable prognosis. Similarly, recovery occurs with time in stunning that follows AMI or cardiac transplantation because in either case the heart had been temporarily anoxic. Clinical observations of ischemic preconditioning include the following: (1) first-effort angina or "warm-up phenomenon," i.e., angina with exercise early, but similar or greater effort the rest of the day does not cause any angina and (2) mortality of AMI is lower in patients with a history of angina preceding AMI. Angina 1 to 2 hours before AMI is the most effective time window for ischemic preconditioning. A less potent "second window" is observed when angina occurs during the second to fourth day before AMI. Adenosine possesses marked cardioprotective properties and has been used to pharmacologically induce ischemic preconditioning with some success. Work is still in progress.
Authors:
L G Futterman; L Lemberg
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of critical care : an official publication, American Association of Critical-Care Nurses     Volume:  9     ISSN:  1062-3264     ISO Abbreviation:  Am. J. Crit. Care     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-01-31     Completed Date:  2001-02-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9211547     Medline TA:  Am J Crit Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  430-6     Citation Subset:  IM; N    
Affiliation:
Department of Medicine, University of Miami School of Medicine, Fla., USA.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / therapeutic use
Angina, Unstable / complications,  therapy
Angioplasty, Transluminal, Percutaneous Coronary*
Chronic Disease
Female
Humans
Ischemic Preconditioning, Myocardial / methods*
Male
Middle Aged
Myocardial Infarction / complications,  therapy
Myocardial Stunning / diagnosis,  etiology,  therapy*
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 58-61-7/Adenosine

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


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