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Intramyocardial Hemorrhage in Acute Myocardial Infarction

Intramyocardial Hemorrhage in Acute Myocardial Infarction Timely primary percutaneous coronary intervention to restore myocardial perfusion is pivotal in acute ST elevation myocardial infarction. The major determinants to reduce myocardial injury before intervention are reducing ischemia duration and severity, and the major determinants after intervention are restoring microvascular flow and minimizing reperfusion injury. When necrosis within the myocardium at risk reaches substantial extent, however, restoration of flow may risk to aggravate the injury by causing intramyocardial hemorrhage (IMH). If microvascular perfusion is restored within ≈30 minutes, myocardial injury is usually detected by troponins, whereas late gadolinium enhancement magnetic resonance imaging (MRI) 1 may demonstrate little or no enhancement as a sign of necrosis. 2 , 3 Myocardial function is often restored completely. With increasing duration of ischemia, however, myocardial cells will progressively lose control of intracellular homeostasis. This leads to progressive myocyte necrosis as a function of time within the myocardium at risk from endocardium to epicardium called the “wavefront phenomenon” by Reimer et al 4 and Reimer and Jennings. 5 The rate at which the amount of infarcted myocardium increases as a result of this process is slower in man compared with most animal experiments. 2 Also, with increasing ischemia duration the swelling of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Circulation: Cardiovascular Imaging Wolters Kluwer Health

Intramyocardial Hemorrhage in Acute Myocardial Infarction

Arheden, Håkan
Circulation: Cardiovascular Imaging , Volume 9 (1): e004418 – Jan 1, 2016
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References (13)

Copyright
© 2016 American Heart Association, Inc.
Subject
10021; 10033; 10099; 10129; 10149; Editorials
ISSN
1941-9651
eISSN
1942-0080
DOI
10.1161/CIRCIMAGING.115.004418
pmid
26763283
Publisher site
See Article on Publisher Site

Abstract

Timely primary percutaneous coronary intervention to restore myocardial perfusion is pivotal in acute ST elevation myocardial infarction. The major determinants to reduce myocardial injury before intervention are reducing ischemia duration and severity, and the major determinants after intervention are restoring microvascular flow and minimizing reperfusion injury. When necrosis within the myocardium at risk reaches substantial extent, however, restoration of flow may risk to aggravate the injury by causing intramyocardial hemorrhage (IMH). If microvascular perfusion is restored within ≈30 minutes, myocardial injury is usually detected by troponins, whereas late gadolinium enhancement magnetic resonance imaging (MRI) 1 may demonstrate little or no enhancement as a sign of necrosis. 2 , 3 Myocardial function is often restored completely. With increasing duration of ischemia, however, myocardial cells will progressively lose control of intracellular homeostasis. This leads to progressive myocyte necrosis as a function of time within the myocardium at risk from endocardium to epicardium called the “wavefront phenomenon” by Reimer et al 4 and Reimer and Jennings. 5 The rate at which the amount of infarcted myocardium increases as a result of this process is slower in man compared with most animal experiments. 2 Also, with increasing ischemia duration the swelling of

Journal

Circulation: Cardiovascular Imaging – Wolters Kluwer Health

Published: Jan 1, 2016

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