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• W135061124 endingPage "151" @default.
• W135061124 startingPage "130" @default.
• W135061124 abstract "SummaryVulnerability of subendocardial muscle to ischemia is enhanced by acquired hypertrophy. The basis of subendocardial ischemia is that an imbalance between myocardial oxygen supply and demand causes selective loss of coronary flow reserve in subendocardial vessels. This can be demonstrated in experiments in which left ventricular work and oxygen consumption are constant while coronary perfusion pressure is lowered in stages. At first, flow remains constant because vessels in all muscle layers dilate. There is, however, a progressive loss of coronary flow reserve, i.e. the extra flow that can be obtained at any pressure when the coronary vessels are maximally dilated. At some lower limit of pressure, total flow decreases due to a selective decrease in subendocardial blood flow. At this stage subendocardial vessels have lost their coronary flow reserve, while the remaining myocardial vessels still have some: thus any decrease in pressure below to critical pressure decreases subendocardial flow causing ischemia.In acquired hypertrophy the total cross-sectional area of the vascular bed is not increased. Myocardial flow per gram of muscle is usually normal; total flow to the hypertrophied muscle is thus increased. The increased myocardial flow is achieved by increased vasodilation at rest. As a result, coronary flow reserve is reduced whenever there is hypertrophy with normal perfusing pressures. Total blood flow is also increased in anemia or tachycardia, and the combination of these with hypertrophy is particularly deleterious. Another harmful combination is the polycythemia and hypoxemia of cyanotic heart disease. Increased viscosity decreases maximal coronary flow, and hypertrophy and hypoxemia raise resting myocardial flow; coronary flow reserve is thus drastically reduced. Similar effects occur when large coronary vessels are stenotic or when there is small-vessel disease of the coronary vascular system.Two factors can prevent a decreased coronary flow reserve. In systemic hypertension the coronary perfusing pressure is high, so that there is a large coronary flow reserve. When ventricular hypertrophy begins in utero or in neonates, the total vascular bed seems to grow in parallel with the increase in muscle mass: coronary flow reserve is thus not compromised. The age at which vascular growth ceases, is unknown." @default.
• W135061124 created "2016-06-24" @default.
• W135061124 creator A5006798908 @default.
• W135061124 creator A5011414876 @default.
• W135061124 creator A5018349633 @default.
• W135061124 creator A5022157493 @default.
• W135061124 date "1983-01-01" @default.
• W135061124 modified "2023-09-27" @default.
• W135061124 title "Total and Transmural Perfusion of the Hypertrophied Heart" @default.
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