EDITORIALS
How stiffening of the aorta and elastic arteries leads to compromised coronary flow
Correspondence to:
Professor M F O’Rourke, Suite 810, St Vincent’s Clinic, 438 Victoria Street, Darlinghurst, NSW 2010, Australia; m.orourke@unsw.edu.au
| The first 150 words of the full text of this article appear below. |
Today’s invasive cardiologist views disturbances in coronary flow from narrowing of epicardial arteries, as seen in a coronary arteriogram. Impairment in coronary flow is attributed to narrowing of the arteries, and relief sought through angioplasty or bypass surgery.1 This is not sufficient to explain angina, particularly in older women, nor the medical approaches that can be directed at its relief.2
Blood flow to the heart is different from blood flow to other parts of the body in that rhythmic contraction of the left ventricle throttles blood vessels during cardiac contraction; in consequence, blood can only enter the left ventricular (LV) arteries during cardiac diastole. This is readily seen in left anterior descending coronary flow tracings as originally recorded by Gregg et al in conscious dogs with implanted flow meters,3 but can now be recorded in humans non-invasively with ultrasound.4 Such tracings do show some forward blood flow in systole, but
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