Document Detail

The pathophysiology of acute myocardial infarction.
MedLine Citation:
PMID:  2663157     Owner:  NLM     Status:  MEDLINE    
Recent work has now clearly established that coronary arterial thrombosis is the direct cause of acute myocardial infarction. This thrombotic event occurs when a pre-existing atherosclerotic plaque ruptures or fissures, thereby exposing underlying thrombogenic material to the circulation. Platelets are thus activated and the clotting cascade is initiated. It is as yet unclear why a previously stable atherosclerotic plaque should fissure or rupture. However, suggested mechanisms include release of vasoactive substances from activated platelets, coronary arterial vasomotion, mechanical stress fatigue of the atherosclerotic plaque, and rupture of vasa vasorum within the atherosclerotic plaque. The resultant cessation of myocardial blood flow produces specific biochemical and physiological alterations secondary to myocardial ischemia. Intracellular acidosis, loss of high-energy phosphates, reduced sensitivity of contractile proteins to calcium, and accumulation of inorganic phosphate and lipid, all occur within the ischemic myocyte. Diastolic compliance is markedly reduced by ischemia followed by cessation of systolic contractile activity. Most of these alterations are reversible if ischemia is relieved promptly. Prolonged ischemia leads to delayed biochemical and physiological recovery and/or cell necrosis.
J S Alpert
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiology     Volume:  76     ISSN:  0008-6312     ISO Abbreviation:  Cardiology     Publication Date:  1989  
Date Detail:
Created Date:  1989-08-14     Completed Date:  1989-08-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  85-95     Citation Subset:  IM    
Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester 01655.
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MeSH Terms
Collateral Circulation
Coronary Artery Disease / complications*
Coronary Circulation
Coronary Disease / complications*
Coronary Thrombosis / complications*
Myocardial Contraction
Myocardial Infarction / etiology,  physiopathology*
Platelet Aggregation

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

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