On the genesis of myocardial ischemia.
About three quarters of myocardial ischemic events are triggered by the autonomic nervous system. The pathognomonic constellation is a combination of an almost complete withdrawal of tonic vagal activity with increased sympathetic activity. The reduction of tonic vagal activity, which is characteristic for ischemic heart disease, and the acute withdrawal of vagal drive preceding the onset of ischemia are not dependent on coronary artery disease. In this paper, the pathophysiological steps that lead from sympathetic-parasympathetic imbalance to myocardial ischemia shall be discussed. A considerable increase of aerobic glycolysis within the myocardium as a result of the autonomic imbalance is of special importance in this process.
Sroka
K
K
Stellinger Weg 47, 20255 Hamburg, Germany. knut.sroka@hamburg.de
D001341:Autonomic Nervous System / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology; D003328:Coronary Thrombosis / Q000209:etiology / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography; D004644:Emotions / Q000502:physiology; D006019:Glycolysis / Q000502:physiology; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008019:Life Style; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control; D012094:Repression, Psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology; D014630:Vagus Nerve / Q000503:physiopathology*