Adenosine, carbohydrates, and ischemic preconditioning

In order to sustain nomml function, the heart is dependent on an adequate delivery of oxygen and substrates to the heart to meet the energy demands of the contracting muscle. Myocardial ischemia can be defined as "an imbalance between the amount of oxygen and substrates supplied to the heart and the amount needed to perfoml normal function". Ischemic heart disease is one of the major causes of death in the world including developing countries. Depending on factors like the amount of collateral flow, myocardial necrosis develops after 10-20 min of ischemia. 'Ischemic preconditioning', one of the 'New Ischemic Syndromes' refers to the mechanism that short periods of (nonlethal) ischemia and reperfusion protect the heart from injury during a subsequent prolonged period of ischemia. It was first described in 1986 by Murry et al. In dog hearts, these investigators showed that infarct size resulting from 40·min coronary artery occlusion was reduced by 75% when ischemia was preceded by four cycles of 5 min coronary artery occlusion and reperfusion.

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