[Metabolic aspects of myocardial ischemia]

Myocardial ischemia can be described as an imbalance of energy demand and energy supply. Even during ischemia, energy metabolism is predominantly aerobic. Only during the most severe underperfusion (residual flow less than 5%) anaerobic metabolism exceeds aerobic metabolism quantitatively. ATP synthesis and ATP metabolism are in a steady state during myocardial ischemia, albeit on a reduced level. A locally low blood flow rate may exist under physiological conditions without the presence of ischemia. The basis for the underlying flow heterogeneity is functional. While experimental data have been widely obtained during acute ischemia, metabolic rates have scarcely been determined during conditions of chronic myocardial ischemia. First experimental studies, however, show that uptake of fluoro-deoxyglucose is enhanced for hours after induction of myocardial stunning and even for months during myocardial hibernation.