Rapid Review·Cardiovascular
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PATHOLOGY
T1Must knowIschemic Heart Disease Manifestations
p307
Focus on
Coronary steal, sudden cardiac death, and the two reversible forms of ischemic dysfunction.
Key takeaways
Coronary steal
What this shows
At baseline
distal to a stenosis, the vessels are already maximally dilated, which is how perfusion is maintained at rest.Give a vasodilator
dipyridamole, adenosine, or regadenoson dilates the normal vessels, dropping their resistance so blood is shunted toward the well-perfused territory.The result
flow to the myocardium fed by the stenosed vessel falls, producing ischemia. The healthy vessels have literally stolen the blood.Sudden cardiac death
Definition
unexpected death from a cardiac cause within 1 hour of symptom onset if witnessed, or within 24 hours of last being seen alive if unwitnessed.Mechanism
most commonly a lethal arrhythmia, i.e. ventricular fibrillation.Causes
coronary artery disease (up to 70%), cardiomyopathy (hypertrophic, dilated), myocarditis, coronary anomalies, and hereditary channelopathies (long QT, Brugada).Prevention
an implantable cardioverter-defibrillator.Chronic ischemic heart disease
What it is
progressive heart failure over many years from chronic ischemic damage to the myocardium.Myocardial hibernation
LV systolic dysfunction from chronic ischemia, potentially reversible with revascularization.Myocardial stunning
transient LV dysfunction after a brief, acute ischemic insult, which recovers spontaneously.| Feature | Myocardial hibernation | Myocardial stunning |
|---|---|---|
| Ischemia | Chronic | Brief and acute |
| Dysfunction | Persistent | Transient |
| Reversible? | Yes, with reperfusion | Yes, spontaneously |
| Classic vignette | EF improves after CABG or stenting | Contractility stays low for days after a successfully reperfused MI |
A patient develops angina and ST depression during an adenosine stress test. Complication or intended?
Intended. Adenosine dilates the healthy vessels, which steal flow from the territory behind the stenosis; that provoked ischemia is exactly what the test looks for.
How it's tested
Each of the three has its own recognisable vignette. Coronary steal: a patient develops angina and ECG changes after receiving dipyridamole or adenosine during a pharmacologic stress test, which is the intended mechanism of the test rather than a complication. Myocardial hibernation: chronic heart failure with a reduced ejection fraction whose contractility improves markedly after revascularization. Myocardial stunning: contractility that stays depressed for a few days after an acute MI despite successful reperfusion, then recovers on its own.
Go deeper
First Aid 2026 — CV/Pathology (p.307) · B&B — Ischemic heart disease manifestations · Mehlman — HY Cardio (stress testing, sudden cardiac death)
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