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Who are the enemies? Lack of oxygen

P.A. Poole-Wilson*

Department of Cardiac Medicine, National Heart & Lung Institute, Faculty of Medicine, Imperial College, London, U.K.

* Correspondence: Philip A. Poole-Wilson, Department of Cardiac Medicine, National Heart & Lung Institute, Faculty of Medicine, Imperial College, Dovehouse Street, London SW3 6LY, U.K.

Abstract

The most common forms of heart disease are linked to coronary atherosclerosis and a reduction in blood flow to the myocardium, notably under stressful conditions. The lack of oxygen can lead to damage to individual myocytes. A more difficult concept is that, in heart failure, the use of oxygen in the heart is misdirected by mechanical inefficiency, by control of metabolic pathways or by blockage of a specific pathway subsequent to the activation of neurohormones and cytokines locally and systemically. Evidence to demonstrate the existence of a specific metabolic abnormality in heart failure is absent. Much of what is observed can be explained by the known damage to myocytes.

Key Words: Hypoxia • ischaemia • metabolism • myocardium • myocytes • oxygen

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