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The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia
Insights
The ischemic cascade details the sequence of events leading to myocardial ischemia, shifting focus from angina to underlying pathophysiologic factors like oxygen supply-demand imbalance.
Area of Science:
- Cardiology
- Pathophysiology
- Myocardial Ischemia
Background:
- Ischemic events, silent or symptomatic, result from cumulative pathophysiologic processes.
- Angina pectoris can be a manifestation of myocardial oxygen supply-demand imbalance.
Purpose of the Study:
- To introduce and explain the concept of the ischemic cascade.
- To reframe the understanding of ischemic events by focusing on preceding pathophysiologic factors.
Main Methods:
- Conceptual framework development.
- Review of pathophysiologic events in myocardial ischemia.
Main Results:
- The ischemic cascade encompasses diminished left ventricular compliance, decreased myocardial contractility, and increased left ventricular end-diastolic pressure.
- ST-segment changes and angina pectoris are potential later manifestations.
Conclusions:
- Understanding the ischemic cascade is crucial for a comprehensive approach to myocardial ischemia.
- Focusing on the cascade shifts attention from angina to the root causes of ischemia.
Abstract:
The development of an ischemic event, whether silent or painful, represents the cumulative impact of a sequence of pathophysiologic events. Each ischemic episode is initiated by an imbalance between myocardial oxygen supply and demand that may ultimately be manifested as angina pectoris. This sequence of events can be termed the ischemic cascade. The significance of this concept resides in the fact that it redirects the focus from the end result--angina--to the more fundamental, underlying pathophysiologic factors that precede it. Specifically, these events include diminished left ventricular compliance, decreased myocardial contractility, increased left ventricular end-diastolic pressure, ST-segment changes and, occasionally, angina pectoris.