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      Historical perspective on the pathology of myocardial ischemia/reperfusion injury.

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          Abstract

          A selective history of the pathophysiological, structural, and metabolic changes found during an episode of severe myocardial ischemia in the canine heart is presented. The changes that cause ischemic injury to become irreversible are discussed in detail because these changes are the target of any successful therapy designed to prevent ischemic cell death. Of these, the disruption of the sarcolemma, an injury the development of which is accelerated in vivo by the contraction of viable tissue elsewhere in the heart traumatizing the ischemic area, plus the changes in high-energy phosphate and the total adenine nucleotide pool are considered to be the critical events leading to the development of irreversibility. The discovery of preconditioning with ischemia is discussed, together with a brief description of postconditioning. Finally, reperfusion injury is discussed in a summary fashion. The evidence for the fact that myocytes are salvaged by reperfusion is presented, as is the evidence that myocytes become unsalvageable by reperfusion as the duration of ischemia increases. The concept that some of the myocytes that die after successful reperfusion with arterial blood actually are killed by changes initiated by reperfusion, so-called lethal reperfusion injury, is attractive in that prevention of this change would lead to greater salvage; however, the prevalence of this phenomenon in clinical practice remains to be determined.

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          Author and article information

          Journal
          Circ. Res.
          Circulation research
          1524-4571
          0009-7330
          Aug 2 2013
          : 113
          : 4
          Affiliations
          [1 ] Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA. RBJenni@aol.com
          Article
          CIRCRESAHA.113.300987
          10.1161/CIRCRESAHA.113.300987
          23908330
          66157bbc-4f65-4151-9d28-e126c518dea8
          History

          ATP depletion,adenine nucleotides adenosine,cyclosporine,diazoxide,ischemic preconditioning,myocardial infarction,reperfusion injury

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