Document Detail

Remodelling of the heart after myocardial infarction.
MedLine Citation:
PMID:  1449447     Owner:  NLM     Status:  MEDLINE    
In the first few hours after the onset of coronary occlusion the infarct zone stretches due to myocyte slippage. Subsequently the noninfarct zone develops volume overload hypertrophy with series addition of new sarcomeres and fibre elongation. Dilatation is detrimental as it increases ventricular wall stress and oxygen demand, and re-entry of electrical impulses may be influenced by stretching of the ischaemic scar resulting in ventricular fibrillation. Left ventricular remodelling and dilatation is a progressive process which begins early and continues in the months after infarction. The major determinants of the extent of remodelling are infarct size and patency of the infarct-related artery. Late reperfusion may reverse initial infarct dilatation and decrease left ventricular volumes by inducing calcium-activated contracture of the actomyosin complex. Expansion may also be inhibited by acceleration of healing, splinting of the infarct zone by salvage of subepicardial cells, and blood in the coronary arteries and veins supporting the infarct zone. End-systolic volume is the strongest predictor of long-term prognosis after infarction. A number of therapies including thrombolysis, angiotensin-converting enzyme (ACE) inhibition and nitrates have been shown to decrease left ventricular dilatation. The optimal time for commencement, dose, duration and the effects of combinations of therapy are yet to be determined.
H D White
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Australian and New Zealand journal of medicine     Volume:  22     ISSN:  0004-8291     ISO Abbreviation:  Aust N Z J Med     Publication Date:  1992 Oct 
Date Detail:
Created Date:  1992-12-30     Completed Date:  1992-12-30     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  1264322     Medline TA:  Aust N Z J Med     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  601-6     Citation Subset:  IM    
Coronary Care Unit, Green Lane Hospital, Auckland, New Zealand.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / pharmacology
Myocardial Infarction / drug therapy,  physiopathology*
Renin-Angiotensin System
Stroke Volume
Thrombolytic Therapy
Time Factors
Ventricular Function, Left / drug effects
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors

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

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