Regional mechanics and energetics of stunned myocardium in vivo

There is still some controversy about the definition of ischemia. a tenn originally derived from ischo hairna (to restrain blood). In this thesis. I would like to follow the defInition of Robert Kloner: "Myocardial ischemia is that state in which blood flow (oxygen and substrate delivery) to the myocardium has been reduced to the point where myocardial metabolism shifts from aerobic to anaerobic and the products of anoxic metabolism accumulate in the tissue. The reduction in blood flow may be absolute, as occurs with a total coronary artery occlusion or relative, as occurs when there is an increase in oxygen demand that outweighs oxygen supply (as in the case of a coronary stenosis in the setting of exercise or rapid pacing)". The reason to choose this definition lies in the fact that an absolute reduction in blood flow is not necessary for ischemia. and that it clearly defInes when blood flow is inadequate. Apart from myocardial stunning, which is defined below. several other ischemic syndromes have been described. In this section I will concisely discuss ischemic preconditioning, myocardial hibernation, and silent ischemia.

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