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[Disorders of microcirculation in coronary heart disease]
H Tillmanns1, W Waas, B Waldecker
1Zentrum für Innere Medizin Abt. Innere Medizin Kardiologie/Angiologie Klinikum der Justus-Liebig-Universität, Giessen.
Insights
Coronary artery disease disrupts microcirculation, impacting blood flow and requiring diagnostic analysis. Treatment involves improving blood flow through various therapeutic strategies.
Area of Science:
- Cardiovascular Medicine
- Physiology
Context:
- Microcirculatory disturbances are a key feature of coronary artery disease.
- These issues arise from critical stenosis, endothelial dysfunction, or post-ischemic recovery.
Purpose:
- To outline diagnostic methods for assessing coronary microcirculation.
- To describe therapeutic strategies for improving microvascular function in cardiovascular disease.
Summary:
- Diagnostic approaches include morphologic analysis, coronary reserve measurement, regional microcirculation imaging (scintigraphy, PET), and hemorheological assessments.
- Post-angioplasty, microcirculation normalization takes 3-6 months.
- Neutrophil activation is observed after angioplasty in myocardial infarction and elective procedures.
Impact:
- Therapeutic interventions focus on increasing perfusion pressure, enhancing blood fluidity, and reducing vascular resistance.
- Effective treatments include revascularization, nitrates, calcium antagonists, physical training, and antihypertensive therapy.
Abstract:
Disturbances of microcirculation in coronary artery disease can be seen in the presence of critical stenosis of epicardial coronary arteries, as a result of endothelial dysfunction in the absence of significant stenosis or during recovery of ischaemic myocardium after successful angioplasty of stenosed or occluded coronary arteries. Diagnostic methods are morphologic/morphometric analyses, measurement of the global coronary reserve, measurement of the regional coronary microcirculation (scintigraphy, positron emission tomography) and laboratory analysis of haemorheological alterations (plasma, erythrocytes, leucocytes). After successful angioplasty, normalisation of glutamate extraction rate takes three to six months. In patients with unstable angina, changes in plasma viscosity, erythrocyte aggregation and neutrophil activation occur. Neutrophils are activated after successful angioplasty in acute myocardial infarction and even after elective angioplasty (when measured in the coronary sinus). Therapeutic improvements of disturbed microvascular flow can be obtained by increasing perfusion pressure (by revascularisation, nitrates, calcium antagonists, physical training), by improving the fluidity of the blood and by reducing the extravascular component of coronary vascular resistance (by antihypertensive treatment).