[Expansion of infarction, dilatation and ventricular remodelling. Therapeutic potential of angiotensin-converting enzyme inhibitors].
Early in the acute phase of myocardial infarction the phenomenon of expansion may occur, with regional thinning and dilatation of necrotic region. This complication may be detected by echocardiography since the first hours of infarction. During the two subsequent weeks, an additional increase of left ventricular volume may occur, due to an increase of length of the infarcted segments and, as well, of the contractile segments which suffer a "volume overload hypertrophy". This is the phenomenon of remodeling. Finally during the first year post infarction, a progressive left ventricular dilatation may develop. This late dilatation seems to be due to an increase of perimeter of the contractile regions only. By the time this topographic changes have occurred, the left ventricle assumes a more spheric configuration. Left ventricular dilatation affects adversely cardiac function, with higher incidences of heart failure and death. Experimental and clinical studies show that, in selected patients, remodeling and ventricular dilatation may be attenuated by the administration of angiotensin-converting-enzyme inhibitors, with better indices of left ventricular function. Final results of several on-going multicenter studies are awaited for; they will allow a better definition of the role of ACE inhibitors on prevention and treatment of left ventricular dysfunction after myocardial infarction.
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UTIC-Arsénio Cordeiro, Hospital de Santa Maria, Lisboa.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D009203:Myocardial Infarction / Q000473:pathology* / Q000503:physiopathology; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors
Expansão de enfarte, dilatação e remodelação ventricular. Potencialidades terapêuticas dos inibidores da enzima de conversão da angiotensina.