Circulation, Vol 66, 1146-1149, Copyright © 1982 by American Heart Association
E Braunwald and RA Kloner
Myocardial ischemia has, for many decades, been viewed as an all-or- none
process that causes myocardial necrosis when prolonged and severe, but
whose effects are transient when it is brief or mild. In view of the
evidence that the ischemic process may "hit, run and stun," perhaps our
thinking about the consequences of myocardial ischemia should be expanded.
According to this formulation, an ischemic insult not of sufficient
severity of duration to produce myocardial necrosis may acutely affect
myocardial repolarization and cause angina (hit); but these changes wane
rapidly (run), when the balance between myocardial oxygen supply and demand
has been reestablished. However, the ischemia may interfere with normal
myocardial function, biochemical processes and ultrastructure for prolonged
periods (stun). The severity and duration of these postischemic changes
depend on the length and intensity of the ischemia, as well as on the
condition of the myocardium at the onset of the ischemic episode.
Furthermore, it is likely that when the myocardium is repeatedly stunned,
it may exhibit chronic postischemic left ventricular dysfunction, an
ill-defined condition. If prolonged, chronic postischemic left ventricular
dysfunction can progress to myocardial scarring and ischemic
cardiomyopathy, it may be important to determine how often it can be
ameliorated by permanent improvement of myocardial perfusion by surgical
treatment.
ARTICLES
The stunned myocardium: prolonged, postischemic ventricular dysfunction
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Y. Abe, M. Kondo, R. Matsuoka, M. Araki, K. Dohyama, and H. Tanio Assessment of clinical features in transient left ventricular apical ballooning J. Am. Coll. Cardiol., March 5, 2003; 41(5): 737 - 742. [Abstract] [Full Text] [PDF]
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S. Kurisu, I. Inoue, T. Kawagoe, M. Ishihara, Y. Shimatani, K. Nishioka, T. Umemura, S. Nakamura, M. Yoshida, and H. Sato Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction J. Am. Coll. Cardiol., March 5, 2003; 41(5): 743 - 748. [Abstract] [Full Text] [PDF]
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S. S. Lee, H. W. Goo, S. B. Park, C. H. Lim, G. Gong, J. B. Seo, and T.-H. Lim MR Imaging of Reperfused Myocardial Infarction: Comparison of Necrosis-Specific and Intravascular Contrast Agents in a Cat Model Radiology, March 1, 2003; 226(3): 739 - 747. [Abstract] [Full Text] [PDF]
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R. Y. Kwong, A. E. Schussheim, S. Rekhraj, A. H. Aletras, N. Geller, J. Davis, T. F. Christian, R. S. Balaban, and A. E. Arai Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging Circulation, February 4, 2003; 107(4): 531 - 537. [Abstract] [Full Text] [PDF]
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F Beygui, C Le Feuvre, G Helft, C Maunoury, and J P Metzger Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction Heart, February 1, 2003; 89(2): 179 - 183. [Abstract] [Full Text] [PDF]
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B. M. Jackson, J. H. Gorman III, I. S. Salgo, S. L. Moainie, T. Plappert, M. St. John-Sutton, L. H. Edmunds Jr., and R. C. Gorman Border zone geometry increases wall stress after myocardial infarction: contrast echocardiographic assessment Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H475 - H479. [Abstract] [Full Text] [PDF]
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P. G Camici and O. E Rimoldi Myocardial blood flow in patients with hibernating myocardium Cardiovasc Res, February 1, 2003; 57(2): 302 - 311. [Abstract] [Full Text] [PDF]
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V K Khoury, B Haluska, J Prins, and T H Marwick Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction Heart, January 1, 2003; 89(1): 61 - 65. [Abstract] [Full Text] [PDF]
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D. C. Lee, W. Ting, and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2003; 2(2003): 639 - 658. [Full Text]
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M. LeBoutillier III and V. J. DiSesa Valvular and Ischemic Heart Disease Card. Surg. Adult, January 1, 2003; 2(2003): 1057 - 1074. [Full Text]
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K. Kitagawa, H. Sakuma, T. Hirano, S. Okamoto, K. Makino, and K. Takeda Acute Myocardial Infarction: Myocardial Viability Assessment in Patients Early Thereafter--Comparison of Contrast-enhanced MR Imaging with Resting 201Tl SPECT Radiology, January 1, 2003; 226(1): 138 - 144. [Abstract] [Full Text] [PDF]
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O. M. Muhling, Y. Wang, P. Panse, M. Jerosch-Herold, M. M. Cayton, L.S. Wann, M. M. Mirhoseini, and N. M. Wilke Transmyocardial laser revascularization preserves regional myocardial perfusion: an MRI first pass perfusion study Cardiovasc Res, January 1, 2003; 57(1): 63 - 70. [Abstract] [Full Text] [PDF]
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E. Braunwald Personal reflections on efforts to reduce ischemic myocardial damage Cardiovasc Res, December 1, 2002; 56(3): 332 - 338. [Full Text] [PDF]
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