Myocardial Ischemia and Its Complications

Atherosclerotic cardiovascular disease is the number one killer of both men and women in industrialized countries. Occlusion of the arteries to the heart, the coronary arteries, leads to myocardial ischemia, an imbalance between oxygen supply and demand in the heart muscle. If the ischemia is of sufficient severity and duration, death of myocardium, myocardial infarction (MI), occurs. This can lead to failure of the heart as a pump, or to electrical system failure leading to arrhythmias and sudden death. Other complications in individuals who survive, include aneurysms, ruptures, and/or valvular dysfunction of the heart. The only effective early treatment to date is to reperfuse the ischemic muscle. Myocardial conditioning can have a temporizing and partially protective effect on evolving MI. As more is learned about the molecular biology of the ischemic myocardium, there is optimism regarding the potential for novel methods of myocardial preservation and regeneration for those who suffer from this disease. This chapter focuses on the morphologic features of the coronary arteries and the heart in patients with ischemic heart disease.