The vicious circle of ischemic left ventricular dysfunction.

Abstract

Myocardial ischemia tends to be self-propagating, and minor events such as plaque rupture can lead to the catastrophic sequelae of myocardial infarction and death. The biology of the endothelium and the cardiac myocyte is crucial to the development of these vicious circles. The abnormal responses of the endothelial cell in atherosclerosis tend to provoke and propagate ischemia, and because of the limited metabolic reserve of the myocyte, even short periods of ischemia can lead to left ventricular dysfunction and arrhythmias. This article examines the clinical implications of the disordered biology of the endothelial cell and the myocyte that is the basis for ischemic left ventricular dysfunction.