[Molecular, cellular and clinical aspects of myocardial ischemia]

The authors summarize the fundamentals and actualities of the molecular and cellular background of myocardial ischaemia-reperfusion for the clinician. Metabolic changes following acute and chronic ischaemia and the role of free radicals, white blood cells, the endothelium, the heat shock proteins are reviewed. "New ischaemic syndromes" are important intrinsic adaptation mechanisms. Stunning is a transient contractile dysfunction following short periods of coronary occlusion in spite of restored perfusion. Hibernating myocardium is resulted after progressive chronic ischaemia including reversible contractile dysfunction, reduced metabolism and cellular dedifferentiation. Preconditioning means concomitant development of a protected state against lethal ischaemia after mild noxious stimuli. Several strategies are considered for myocardial cytoprotection based on the complex physiopathology of ischaemia-induced injury.