Pathophysiology of heart failure following myocardial infarction

A D Struthers

Correspondence to:
Correspondence to:
Professor Allan D Struthers
Division of Medicine and Therapeutics, Ninewells Hospital, Dundee DD1 9SY, UK; a.d.struthers{at}dundee.ac.uk

The structural and functional abnormalities that lead to cardiac death are coronary artery disease and left ventricular abnormalities related to remodelling (left ventricular hypertrophy, left ventricular systolic dysfunction, and left ventricular fibrosis). Aldosterone adversely affects all of these processes. It produces both a vasculopathy and left ventricular dysfunction and fibrosis. Endothelial dysfunction in the coronary arteries can lead to acute coronary events. Left ventricular dysfunction will cause the progression of heart failure, and left ventricular fibrosis and dysfunction provide an arrhythmic substrate. The combination of acute coronary events and arrhythmias can lead to sudden cardiac deaths, while acceleration of the heart failure disease process can lead to deaths from progressive heart failure. The increased understanding of the mechanistic role of aldosterone in cardiovascular disease provides a rationale for the positive results that have been seen in clinical trials of aldosterone blockade.

Abbreviations: ACE, angiotensin converting enzyme; COX-2, cyclo-oxygenase- 2; L-NMMA, N-monomethyl-L-arginine; MI, myocardial infarction; PIII NP, procollagen type III amino terminal peptide; VCAM-1, vascular cell adhesion molecule-1

Keywords: aldosterone; heart failure; myocardial infarction

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• McGaffin, K. R., Sun, C.-K., Rager, J. J., Romano, L. C., Zou, B., Mathier, M. A., O'Doherty, R. M., McTiernan, C. F., O'Donnell, C. P. (2008). Leptin signalling reduces the severity of cardiac dysfunction and remodelling after chronic ischaemic injury. Cardiovasc Res 77: 54-63 [Abstract] [Full Text]  
• Bunch, T. J., Hohnloser, S. H., Gersh, B. J. (2007). Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors: Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators. Circulation 115: 2451-2457 [Full Text]