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Coronary Vascular Adjustments to Acute Myocardial Ischemia

Coronary Vascular Adjustments to Acute Myocardial Ischemia Abstract Coronary occlusion causes increased flow in adjacent arteries due to increased myocardial oxygen consumption in the area of the unoccluded arteries. Interarterial collateral circulation increases after coronary occlusion and is rapidly mobilized with repeat occlusion. There is some collateral flow from the cardiac cavities to the myocardium with coronary occlusion but this is via retrograde perfusion of venous drainage channels in the atria and right ventricle rather than directly from the left ventricular cavity. Endocardial distribution of coronary flow is equal to that of the epicardium in the normal or hypertensive left ventricle but the inner layers of the ischemic left ventricle show a marked restriction of flow. Coronary autoregulatory mechanisms are immediately mobilized by acute myocardial ischemia but the metabolic adenosine hypothesis appears unlikely to be the sole cause of the vasodilatory response. References 1. LeRoy CV, Fenn GK, Gilbert NC: The influence of xanthine drugs and atropine on the mortality rate after experimental occlusion of a coronary artery. Amer Heart J 23:637-643, 1942.Crossref 2. Manning GW, McEachern CG, Hall GE: Reflex coronary artery spasm following occlusion of other coronary branches. Arch Intern Med 64:661-674,1939.Crossref 3. McEachern CG, Manning GW, Hall GE: Sudden occlusion of coronary arteries following removal of cardiosensory pathways. Arch Intern Med 65:661-670, 1940.Crossref 4. Herzberg RM, Rubio R, Berne RM: Coronary occlusion and embolization: Effect on blood flow in adjacent arteries. Amer J Physiol 210:169-175, 1966. 5. Joyce EE, Gregg DE: Coronary artery occlusion in the intact unanesthetized dog: Intercoronary reflexes. Amer J Physiol 213:64-70, 1967. 6. Driscol TE, Eckstein RW: Coronary inflow and outflow responses to coronary artery occlusion. Circ Res 20:485-495, 1967.Crossref 7. Bloor CM, Liebow AA: Coronary collateral circulation. Amer J Cardiol 16:238-252, 1965.Crossref 8. Pasyk S, Bloor CM, Khouri EM, et al: Systemic and coronary effects of coronary artery occlusion in the unanesthetized dog. Amer J Physiol 220:646-654, 1971. 9. Elliot EC, Bloor CM, Jones EL, et al: Effect of controlled coronary occlusion on collateral circulation in conscious dogs. Amer J Physiol 220:857-861, 1971. 10. Khouri EM, Gregg DE, McGranahan GM: Regression and reappearance of coronary collaterals. Amer J Physiol 220:655-661, 1971. 11. Moir TW: Study of luminal coronary collateral circulation in the beating canine heart. Circ Res 24:735-744, 1969.Crossref 12. Gregg DE, Fisher LC: Blood supply to the heart , in Handbook of Physiology . Washington, DC, American Physiological Society, 1963, vol 2, pp 1567-1573. 13. Wearn JT, Mettier SR, Klump TG, et al: Nature of the vascular communications between the coronary arteries and the chambers of the heart. Amer Heart J 9:143-164, 1933.Crossref 14. Moir TW, Driscol TE, Eckstein R: Thebesian drainage in the left heart of the dog. Circ Res 14:245-249, 1964.Crossref 15. Wiggers CJ: Functional importance of coronary collaterals. Circulation 5:609-615, 1952.Crossref 16. Massimo C, Boffi L: Myocardial revascularization by a new method of carrying blood directly from the left ventricular cavity into the coronary circulation. J Thorac Surg 34:257-263, 1957. 17. Berger RL, Robbins SL, Rodriguez FL: Effect of de-endocardialization on myocardial blood supply. Circulation 30( (suppl 3) ):2, 1964. 18. Wakabayashi A, Little JT, Connolly JE: Myocardial boring for the ischemic heart , in Proceedings of the International Cardiovascular Society, North American Chapter , Atlantic City, NJ, June 16, 1967, p 12. 19. Khazei AH, Kime WP, Popodopoulos C, et al: Myocardial revascularization: A new method. Circulation 36( (suppl 2) ):160, 1967. 20. Anabtawi IN, Riegler HF, Ellison RG: Experimental evaluation of myocardial tunnelization as a methol of myocardial revascularization. Circulation 38( (suppl 6) ):133, 1968. 21. Helfant RH, Vokonas PS, Gorlin R: Functional importance of the human coronary collateral circulation. New Eng J Med 284:1277-1280, 1971.Crossref 22. Miller RR, Mason DT, Zelis R, et al: The coronary collateral circulation in man: Relation to regional atherosclerosis and evaluation of protective role in clinical course and cardiac function. Clin Res 19:328, 1971. 23. Guyton AC: Collaterals, blood flow and tissue nutrition. New Eng J Med 284:1323-1324, 1971.Crossref 24. Laszt VL, Muller A: Der Myocardiale Drucke. Helv Physiol Acta 16:88-106, 1958. 25. Kirk ES, Honig CR: An experimental and theoretical analysis of myocardial tissue pressure. Amer J Physiol 207:361-367, 1964. 26. Armour JA, Randall WC: Canine left ventricular intramyocardial pressure. Amer J Physiol 220:1833-1839, 1971. 27. Moir TW, DeBra DW: Effect of left ventricular hypertension, ischemia and vasoactive drugs on the myocardial distribution of coronary flow. Circ Res 21:65-73, 1967.Crossref 28. Love WD, Burch GE: Differences in the rate of Rb86 uptake by several regions of the myocardium of control dogs and dogs receiving l-norepinephrine or pitressin. J Clin Invest 36:479-484, 1957.Crossref 29. Cutarelli R, Levy MN: Intraventricular pressure and distribution of coronary blood flow. Circ Res 12:322-327, 1963.Crossref 30. Griggs DM Jr, Nakamura Y: Effect of coronary constriction on myocardial distribution of iodo-antipyrine-131I. Amer J Physiol 215:1082-1088, 1968. 31. Palmer WH, Fam WM, McGregor M: Effect of coronary vasodilation (dipyridamole-induced) on the myocardial distribution of tritiated water. Canad J Physiol Pharmacol 44:777-782, 1966.Crossref 32. Becker LC, Fortunin NJ, Pitt B: Effect of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circ Res 28:263-269, 1971.Crossref 33. Kirk ES, Honig CR: Nonuniform distribution of blood flow and gradients in oxygen tension within the heart. Amer J Physiol 207:661-668, 1964. 34. Winbury MM: Redistribution of left ventricular blood flow produced by nitroglycerin. Circ Res 28 ( (suppl 1) ):140-147, 1971. 35. Griggs DM Jr, De Clue JW, Tchokoev VV: Transmural myocardial metabolism and the effects thereon of isoproterenol. Fed Proc 28:451, 1969. 36. Griggs DM Jr, Tchokoev VV, McClue JW: Effect of epinephrine administration on transmural myocardial metabolism. Fed Proc 29:449, 1970. 37. Leunissen RLA, Piatnek-Leunissen DA, Nakamura Y, et al: Regional metabolism of the heart during reduced coronary flow. Circulation 34( (suppl 3) ):155, 1966. 38. Myers WM, Honig CR: Number and distribution of capillaries as determinants of myocardial oxygen tension. Amer J Physiol 207:653-660, 1964. 39. Tschopp HM, Rakusan K, Gudbjarnason S, et al: Physiologic studies on revascularization of the dog heart. J Thorac Cardiovasc Surg 55:466-478, 1968. 40. Dixon W, Massey F: Introduction to Statistical Analysis , ed 2. New York, McGraw-Hill Book Co Inc, 1957. 41. Guyton AC, Ross JM, Carrier 0, et al: Evidence for tissue oxygen demands as the major factor causing autoregulation. Circ Res 15( (suppl 1) ):60-69, 1964. 42. Duling BR, Berne RM: Oxygen and the local regulation of blood flow: Possible significance of longitudinal gradients in arterial blood oxygen tension. Circ Res 28( (suppl 1) ):65-69, 1971. 43. Berne RM, Rubio R, Dobson JG, et al: Adenosine and adenine nucleotides as possible mediators of cardiac and skeletal muscle blood flow regulation. Circ Res 28( (suppl 1) ):115-119, 1971. 44. Rubio R, Berne RM, Katori M: Release of adenosine in reactive hyperemia of the dog heart: Amer J Physiol 216:56-62, 1969. 45. Olsson RA: Changes in content of purine nucleoside in canine myocardium during coronary occlusion. Circ Res 26:301-306, 1970.Crossref 46. Moir TW: Effect of adrenergic block on adenosine induced coronary vasodilation. Fed Proc 29:586, 1970. 47. Moir TW, Downs TD: Reactive hyperemia and the vasodilatory effects of adenosine and the adenine nucleotides. J Lab Clin Med 76:851, 1970. 48. Detar R, Gellai M: Oxygen, adenosine and isolated coronary arterial vascular smooth muscle. Physiologist 14:132, 1971. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Coronary Vascular Adjustments to Acute Myocardial Ischemia

Archives of Internal Medicine , Volume 129 (5) – May 1, 1972

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American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320050123013
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Abstract

Abstract Coronary occlusion causes increased flow in adjacent arteries due to increased myocardial oxygen consumption in the area of the unoccluded arteries. Interarterial collateral circulation increases after coronary occlusion and is rapidly mobilized with repeat occlusion. There is some collateral flow from the cardiac cavities to the myocardium with coronary occlusion but this is via retrograde perfusion of venous drainage channels in the atria and right ventricle rather than directly from the left ventricular cavity. Endocardial distribution of coronary flow is equal to that of the epicardium in the normal or hypertensive left ventricle but the inner layers of the ischemic left ventricle show a marked restriction of flow. Coronary autoregulatory mechanisms are immediately mobilized by acute myocardial ischemia but the metabolic adenosine hypothesis appears unlikely to be the sole cause of the vasodilatory response. References 1. LeRoy CV, Fenn GK, Gilbert NC: The influence of xanthine drugs and atropine on the mortality rate after experimental occlusion of a coronary artery. Amer Heart J 23:637-643, 1942.Crossref 2. Manning GW, McEachern CG, Hall GE: Reflex coronary artery spasm following occlusion of other coronary branches. Arch Intern Med 64:661-674,1939.Crossref 3. McEachern CG, Manning GW, Hall GE: Sudden occlusion of coronary arteries following removal of cardiosensory pathways. Arch Intern Med 65:661-670, 1940.Crossref 4. Herzberg RM, Rubio R, Berne RM: Coronary occlusion and embolization: Effect on blood flow in adjacent arteries. Amer J Physiol 210:169-175, 1966. 5. Joyce EE, Gregg DE: Coronary artery occlusion in the intact unanesthetized dog: Intercoronary reflexes. Amer J Physiol 213:64-70, 1967. 6. Driscol TE, Eckstein RW: Coronary inflow and outflow responses to coronary artery occlusion. Circ Res 20:485-495, 1967.Crossref 7. Bloor CM, Liebow AA: Coronary collateral circulation. Amer J Cardiol 16:238-252, 1965.Crossref 8. Pasyk S, Bloor CM, Khouri EM, et al: Systemic and coronary effects of coronary artery occlusion in the unanesthetized dog. Amer J Physiol 220:646-654, 1971. 9. Elliot EC, Bloor CM, Jones EL, et al: Effect of controlled coronary occlusion on collateral circulation in conscious dogs. Amer J Physiol 220:857-861, 1971. 10. Khouri EM, Gregg DE, McGranahan GM: Regression and reappearance of coronary collaterals. Amer J Physiol 220:655-661, 1971. 11. Moir TW: Study of luminal coronary collateral circulation in the beating canine heart. Circ Res 24:735-744, 1969.Crossref 12. Gregg DE, Fisher LC: Blood supply to the heart , in Handbook of Physiology . Washington, DC, American Physiological Society, 1963, vol 2, pp 1567-1573. 13. Wearn JT, Mettier SR, Klump TG, et al: Nature of the vascular communications between the coronary arteries and the chambers of the heart. Amer Heart J 9:143-164, 1933.Crossref 14. Moir TW, Driscol TE, Eckstein R: Thebesian drainage in the left heart of the dog. Circ Res 14:245-249, 1964.Crossref 15. Wiggers CJ: Functional importance of coronary collaterals. Circulation 5:609-615, 1952.Crossref 16. Massimo C, Boffi L: Myocardial revascularization by a new method of carrying blood directly from the left ventricular cavity into the coronary circulation. J Thorac Surg 34:257-263, 1957. 17. Berger RL, Robbins SL, Rodriguez FL: Effect of de-endocardialization on myocardial blood supply. Circulation 30( (suppl 3) ):2, 1964. 18. Wakabayashi A, Little JT, Connolly JE: Myocardial boring for the ischemic heart , in Proceedings of the International Cardiovascular Society, North American Chapter , Atlantic City, NJ, June 16, 1967, p 12. 19. Khazei AH, Kime WP, Popodopoulos C, et al: Myocardial revascularization: A new method. Circulation 36( (suppl 2) ):160, 1967. 20. Anabtawi IN, Riegler HF, Ellison RG: Experimental evaluation of myocardial tunnelization as a methol of myocardial revascularization. Circulation 38( (suppl 6) ):133, 1968. 21. Helfant RH, Vokonas PS, Gorlin R: Functional importance of the human coronary collateral circulation. New Eng J Med 284:1277-1280, 1971.Crossref 22. Miller RR, Mason DT, Zelis R, et al: The coronary collateral circulation in man: Relation to regional atherosclerosis and evaluation of protective role in clinical course and cardiac function. Clin Res 19:328, 1971. 23. Guyton AC: Collaterals, blood flow and tissue nutrition. New Eng J Med 284:1323-1324, 1971.Crossref 24. Laszt VL, Muller A: Der Myocardiale Drucke. Helv Physiol Acta 16:88-106, 1958. 25. Kirk ES, Honig CR: An experimental and theoretical analysis of myocardial tissue pressure. Amer J Physiol 207:361-367, 1964. 26. Armour JA, Randall WC: Canine left ventricular intramyocardial pressure. Amer J Physiol 220:1833-1839, 1971. 27. Moir TW, DeBra DW: Effect of left ventricular hypertension, ischemia and vasoactive drugs on the myocardial distribution of coronary flow. Circ Res 21:65-73, 1967.Crossref 28. Love WD, Burch GE: Differences in the rate of Rb86 uptake by several regions of the myocardium of control dogs and dogs receiving l-norepinephrine or pitressin. J Clin Invest 36:479-484, 1957.Crossref 29. Cutarelli R, Levy MN: Intraventricular pressure and distribution of coronary blood flow. Circ Res 12:322-327, 1963.Crossref 30. Griggs DM Jr, Nakamura Y: Effect of coronary constriction on myocardial distribution of iodo-antipyrine-131I. Amer J Physiol 215:1082-1088, 1968. 31. Palmer WH, Fam WM, McGregor M: Effect of coronary vasodilation (dipyridamole-induced) on the myocardial distribution of tritiated water. Canad J Physiol Pharmacol 44:777-782, 1966.Crossref 32. Becker LC, Fortunin NJ, Pitt B: Effect of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circ Res 28:263-269, 1971.Crossref 33. Kirk ES, Honig CR: Nonuniform distribution of blood flow and gradients in oxygen tension within the heart. Amer J Physiol 207:661-668, 1964. 34. Winbury MM: Redistribution of left ventricular blood flow produced by nitroglycerin. Circ Res 28 ( (suppl 1) ):140-147, 1971. 35. Griggs DM Jr, De Clue JW, Tchokoev VV: Transmural myocardial metabolism and the effects thereon of isoproterenol. Fed Proc 28:451, 1969. 36. Griggs DM Jr, Tchokoev VV, McClue JW: Effect of epinephrine administration on transmural myocardial metabolism. Fed Proc 29:449, 1970. 37. Leunissen RLA, Piatnek-Leunissen DA, Nakamura Y, et al: Regional metabolism of the heart during reduced coronary flow. Circulation 34( (suppl 3) ):155, 1966. 38. Myers WM, Honig CR: Number and distribution of capillaries as determinants of myocardial oxygen tension. Amer J Physiol 207:653-660, 1964. 39. Tschopp HM, Rakusan K, Gudbjarnason S, et al: Physiologic studies on revascularization of the dog heart. J Thorac Cardiovasc Surg 55:466-478, 1968. 40. Dixon W, Massey F: Introduction to Statistical Analysis , ed 2. New York, McGraw-Hill Book Co Inc, 1957. 41. Guyton AC, Ross JM, Carrier 0, et al: Evidence for tissue oxygen demands as the major factor causing autoregulation. Circ Res 15( (suppl 1) ):60-69, 1964. 42. Duling BR, Berne RM: Oxygen and the local regulation of blood flow: Possible significance of longitudinal gradients in arterial blood oxygen tension. Circ Res 28( (suppl 1) ):65-69, 1971. 43. Berne RM, Rubio R, Dobson JG, et al: Adenosine and adenine nucleotides as possible mediators of cardiac and skeletal muscle blood flow regulation. Circ Res 28( (suppl 1) ):115-119, 1971. 44. Rubio R, Berne RM, Katori M: Release of adenosine in reactive hyperemia of the dog heart: Amer J Physiol 216:56-62, 1969. 45. Olsson RA: Changes in content of purine nucleoside in canine myocardium during coronary occlusion. Circ Res 26:301-306, 1970.Crossref 46. Moir TW: Effect of adrenergic block on adenosine induced coronary vasodilation. Fed Proc 29:586, 1970. 47. Moir TW, Downs TD: Reactive hyperemia and the vasodilatory effects of adenosine and the adenine nucleotides. J Lab Clin Med 76:851, 1970. 48. Detar R, Gellai M: Oxygen, adenosine and isolated coronary arterial vascular smooth muscle. Physiologist 14:132, 1971.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1972

References