Etiology and patogenesis of ischemic heart disease

Abstract

Ischemic heart disease (IHD) is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand. The most common cause of myocardial ischemia is atherosclerotic disease of an epicardial coronary artery (or arteries) sufficient to cause a regional reduction in myocardial blood flow and inadequate perfusion of the myocardium supplied by the involved coronary artery. Although risk factors for atherosclerosis development are largely known, the pathogenesis of disease is still matter of discussion. The investigation during the last decades have provided new date related to the role of endothelial dysfunction, and particularly role of immune cell-mediated mechanisms in pathogenesis of the disease. The data elucidating role of immunopathogenetic mechanisms in the development of atherosclerotic lesions and their complications provided a strong basis for designing a new generation of drugs to combat aterosclerosis, and thereby to prevent ischemic heart disease.

Ishemijsku bolest srca karakteriše nedovoljno snabdevenje krvlju, odnosno kiseonikom, dela miokarda. Nastaje onda kada postoji nesklad između količine kiseonika koja se doprema cirkulacijom u miokard i njegovih potreba u kiseoniku. Najčešći uzrok smanjenog snabdevanja krvlju miokarda je aterosklerotska bolest jedne ili više epikardnih koronarnih arterija, koja sužava lumen i, sledstveno smanjuje. Iako su faktori rizika za razvoj ateroskleroze uglavnom poznati mehanizmi razvoja aterosklerotskih promena još uvek nisu u potpunosti razjašnjeni. Poslednje decenije donele su niz novih saznanja, vezanih za ulogu disfunkcije endotela u inicijaciji i progresiji ateroskerotskih promena i posebno za ulogu ćelija imunskog sistema i imunskih mehanizama u patogenezi ovog oboljenja. Saznanja vezana za ulogu imunopatogenetskih mehanizana stvorila su značajnu osnovu za dizajniranje nove generacije lekova za terapiju aterosklerose i time prevencu ishemijske bolesti srca.