[Endogenous mechanisms for protection in myocardium]

New opinions about myocardial adaptation during ischaemia are described in presented article. Myocardial preservation mechanisms in response to ischaemia are divided into metabolic adaptation like preconditioning and hibernation and anatomic mechanisms of adaptation like development of collateral circulation. Adaptation in clinical conditions can be observed in few situations. 1) During repeated in short period of time exercise tests (warm up). Adaptation may express through increasing tolerated ischemic burden, lenghtening time of exercise, increasing of ischaemic threshold and double product during successive exercise tests (predominately second). This phenomenon called warm up is a clinical counterpart of myocardial preconditioning. 2) In study during coronary angioplasty demonstrated that decrease of ST-segment, intensity of thoracic pain and serum lactacidaemia was lower during the second balloon inflation than the first. 4) The example of myocardial adaptation is repeated atrial stimulation. Ischaemic myocardium should be treated like some kind of mosaic of necrosis, hibernation, stunning and normal viability.