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the middle muscular layer of the heart wall

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/24 01:03:19」(JST)

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In cardiology, stunned myocardium is a state when some section of the myocardium (corresponding to area of a major coronary occlusion) shows a form of contractile abnormality. This is a segmental dysfunction which persists for a variable period of time, about two weeks, even after ischemia has been relieved (by for instance angioplasty or coronary artery bypass surgery). In this situation, while myocardial blood flow (MBF) returns to normal, function is still depressed for a variable period of time.

Myocardial stunning is the reversible reduction of function of heart contraction^[1] after reperfusion not accounted for by tissue damage or reduced blood flow.^[2]

After total ischemia occurs, the myocardium switches immediately form aerobic glycolysis to anaerobic glycolysis resulting in the reduced ability to produce high energy phosphates such as ATP and Creatinine Phosphate. At this point, the lack of the energy and lactate accumulation results in cessation of contraction within 60 seconds of ischemia (i.e. Vessel Occlusion). Subsequent to this is a period of "myocardial stunning," in which reversible ischemic damage is taking place. At approximately 30 minutes after the onset of total ischemia the damage becomes irreversible, thereby ending the phase of myocardial stunning.

Clinical situations of stunned myocardium are:

acute myocardial infarction (AMI)
after percutaneous transluminal coronary angioplasty (PTCA)
after cardiac surgery
'neurogenic' stunned myocardium following an acute cerebrovascular event such as a subarachnoid hemorrhage

References

^ Myocardial Stunning at the US National Library of Medicine Medical Subject Headings (MeSH)
^ Grund F (February 2001). "[Three cardiac mysteries--stunning, hibernation and ischemic preconditioning]". Tidsskr. Nor. Laegeforen. (in Norwegian) 121 (4): 440–4. PMID 11255859.

External links

"Myocardial “stunning” in man"
Baker C, Rimoldi O, Camici P, Barnes E, Chacon M, Huehns T, Haskard D, Polak J, Hall R (1999). "Repetitive myocardial stunning in pigs is associated with the increased expression of inducible and constitutive nitric oxide synthases.". Cardiovasc Res 43 (3): 685–97. doi:10.1016/S0008-6363(99)00149-2. PMID 10690340.
Wittstein IS; Thiemann DR; Lima JA et al. (February 2005). "Neurohumoral features of myocardial stunning due to sudden emotional stress". N. Engl. J. Med. 352 (6): 539–48. doi:10.1056/NEJMoa043046. PMID 15703419.

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1. 気絶心筋または冬眠心筋の臨床的症候群 clinical syndromes of stunned or hibernating myocardium
2. 気絶心筋または冬眠心筋の病態生理 pathophysiology of stunned or hibernating myocardium
3. 冬眠心筋の評価 evaluation of hibernating myocardium
4. ストレス（たこつぼ型）心筋症 stress takotsubo cardiomyopathy
5. コントラスト心エコー検査：臨床応用 contrast echocardiography clinical applications

English Journal

Cardioprotection acquired through exercise: the role of ischemic preconditioning.

Marongiu E, Crisafulli A1.
Current cardiology reviews.Curr Cardiol Rev.2014 Nov;10(4):336-48.
A great bulk of evidence supports the concept that regular exercise training can reduce the incidence of coronary events and increase survival chances after myocardial infarction. These exercise-induced beneficial effects on the myocardium are reached by means of the reduction of several risk factor
PMID 24720421

Sepsis-induced myocardial depression and takotsubo syndrome.

Y-Hassan S1, Settergren M, Henareh L.
Acute cardiac care.Acute Card Care.2014 Sep;16(3):102-9. doi: 10.3109/17482941.2014.920089. Epub 2014 Jun 23.
Abstract Background and objectives: Myocardial depression in the setting of sepsis and septic shock is common and has been recognized for a long time. The aim of this study is to find out an association and causal link between sepsis and takotsubo syndrome (TS).METHODS: Fifteen cases of TS were stud
PMID 24955937

Myocardial viability and microvascular obstruction: role of cardiac magnetic resonance imaging.

Romero J1, Lupercio F, Haramati LB, Garcia MJ, Lucariello RJ.
Cardiology in review.Cardiol Rev.2014 Sep-Oct;22(5):246-52. doi: 10.1097/CRD.0000000000000024.
Established coronary artery disease has a prevalence of 7% in adult Americans, accounting for 16 million people. As morbidity and mortality rates have risen, research efforts to identify the pathophysiologic mechanisms of systolic dysfunction have risen in parallel. The current goal is to develop ne
PMID 24621860

Japanese Journal

Milrinone and levosimendan administered after reperfusion improve myocardial stunning in swine

Scandinavian Cardiovascular Journal 47(1), 50-57, 2013-02
NAID 120005230617

Coronary Spastic Angina Causing Myocardial Stunning Associated with Reversible Wall Thinning and Motion Abnormality of the Left Ventricle: A Case Report