[Acute myocardial infarction: recent physiopathological data. 1: acute coronary occlusion].
Acute myocardial infarction is the result of sudden coronary occlusion in the absence of a collateral circulation. There main factors are required for this to occur: an acute parietal lesion on a stenosis of variable, sometimes minor, importance; local coronary vasoconstriction and a platelet and fibrin thrombus. Parietal fissuration is the commonest "trigger" of coronary spasm and the thrombotic cascade. All factors of coronary occlusion are potentially reversible--vasodilation--platelet anti-aggregation--physiological fibrinolysis--remodeling and cicatrisation of the plaque, thereby explaining cases of spontaneous regression of occlusion (10% at 1 hour; 20% at 6 hours; 30% at 24 hours; 50 to 70% at 1 year). The pathogenesis of myocardial infarction with angiographically normal coronary arteries may be reviewed and attributed to acute parietal fissuration at a non-significant or angiographically undetectable plaque resulting in occlusive thrombosis. In this case, the role of other pathogenic factors is also discussed (diabetes, oral contraception, haemostatic abnormalities, platelet disorders...).
Monassier
J P
JP
Service de cardiologie, centre hospitalier du Hasenrain, Mulhouse.
Hanssen
M
M
Ameur
C
C
Weisse
D
D
Zimmermann
A
A
Laval
G
G
D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology*; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology
Infarctus myocardique aigu: données physiopathologiques récentes. Première partie: l'occlusion coronaire aiguë.