Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction

Area of Science:

• Cardiology
• Pathophysiology
• Internal Medicine

Background:

• Ischemic heart disease (IHD) poses a significant global health burden.
• Conventional understanding equates IHD with obstructive atherosclerotic plaques in coronary arteries.
• Clinical and autoptic data reveal a more complex, multifaceted pathophysiology beyond simple plaque obstruction.

Purpose of the Study:

• To provide a comprehensive overview of IHD pathophysiological mechanisms.
• To challenge the sole reliance on atherosclerotic plaque complication as the cause of IHD.
• To explore diverse pathophysiological paradigms, including plaque activation and microvascular dysfunction.

Main Methods:

• Review and synthesis of existing clinical, angiographic, and autoptic findings.
• Analysis of current literature on IHD pathophysiology.
• Exploration of established and emerging pathophysiological concepts.

Main Results:

• IHD pathophysiology is not solely explained by severe or complicated atherosclerotic plaques.
• Mechanisms range from plaque activation and instability to microvascular dysfunction.
• A multifaceted approach is needed to understand everyday IHD cases.

Conclusions:

• Current assessments of IHD pathophysiology are insufficient to explain all observed phenomena.
• Recognizing diverse mechanisms is essential for accurate diagnosis and future therapeutic strategies.
• A broader understanding, encompassing plaque dynamics and microvascular function, is vital for managing IHD.