Physiopathological basis of protection of the ischemic myocardium

: Ischemia initiates a cascade of intracellular events that culminates in the death of the myocyte. Reperfusion of ischemic myocardium is the most efficient way of salvaging jeopardized cells. Additional measures referred to as "myocardial protection" may further reduce ischemic injury, primarily by delaying the progression of cellular damage during ischemia. The pathophysiological aspects of ischemic injury and the possibilities for protection of ischemic myocardium are reviewed. In addition to the "established" methods of myocardial protection, the concept of prevention of "reperfusion injury", presently under experimental investigation, is discussed.