Microvasculature in acute myocardial ischemia: Part II - Evolving concepts in pathophysiology, diagnosis, and treatment

MCE has provided valuable information regarding the microcirculation in animal models as well as in humans. In this brief update, we have tried to summarize the state of the microcirculation during stress-induced ischemia, AMI, and inflammation caused by reperfusion. We have also highlighted the importance of capillary resistance and blood viscosity, as well as collateral blood flow, in maintaining myocardial viability. We have discussed treatment options aimed at increasing flow to regions with microvascular obstruction to improve outcome. Future progress in AMI therapy will be geared toward protecting the myocardium during ischemic and reperfusion injury through improvement in microvascular flow and function. In order to achieve this goal, a comprehensive understanding of the normal and abnormal workings of the coronary microcirculation is essential. We hope this Clinical Update contributes in small measure toward that understanding.