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Medical measures for reduction of myocardial infarct size

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Invasive Cardiovascular Therapy

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 57))

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Summary

Most of our knowledge about biology of myocardial infarction were obtained in animal studies. About 30 min after occlusion of a coronary artery infarcts started to develop in the jeopardized subendocardium and spread towards the ischemic subepicardium like a wave front. The speed at which ischemic myocytes die depends on the amount of collateral and/or residual blood flow and the left ventricular oxygen consumption. Experimental animal studies suggest that early reperfusion is the most potent measure to reduce infarct size. Under certain circumstances a reduction of left ventricular oxygen consumption may reduce myocardial infarct size even in the absence of reflow. Early reperfusion seems to be associated with the treatable reperfusion injury. The interpretation of studies in man are difficult because we lack accurate means to clinically determine the risk region and the corresponding infarction. The best treatment to reduce infarct size in man is still unknown. At the present time we favor the administration of nitroglycerin, heparin, and analgetics combined with early reperfusion.

The fate of patients who survived the acute event of a myocardial infarction is in part determined by the extent of the necrotic region. Patients with larger infarctions are at a greater risk to die due to heart failure [1] or on account of ventricular fibrillation [2]. Besides the control of rhythm disturbances in a treatment aimed to reduce myocardial infarct size is highly desirable to improve the prognosis and quality of life in these patients. During the last two decades we have learnt a great deal about the biology of myocardial infarction, especially by experimental animal research. In the first part of this paper we will therefore review some important aspects obtained in experimental studies. In the second part we will evaluate clinical trials to reduce infarct size in man.

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Authors
  1. H. H. Klein
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  2. H. Kreuzer
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Editors and Affiliations

  1. Medical Clinic III, Department of Cardiology, University of Cologne, Joseph-Stelzmann-Strasse 9, 5000, Cologne 41, Federal Republic of Germany

    H. H. Hilger  & V. Hombach  & 

  2. Cardiovascular Laboratories, The Children’s Hospital of Philadelphia One Children’s Center, 34th Street and Civic Center Bvd, Philadelphia, PA, USA

    W. J. Rashkind

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© 1987 Martinus Nijhoff Publishers, Dordrecht

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Klein, H.H., Kreuzer, H. (1987). Medical measures for reduction of myocardial infarct size. In: Hilger, H.H., Hombach, V., Rashkind, W.J. (eds) Invasive Cardiovascular Therapy. Developments in Cardiovascular Medicine, vol 57. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4293-6_27

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  • DOI: https://doi.org/10.1007/978-94-009-4293-6_27

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-8408-6

  • Online ISBN: 978-94-009-4293-6

  • eBook Packages: Springer Book Archive

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