Origin, Prediction and Prevention of Ischemic Heart Disease
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概要
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Extensive investigations over the last 20 years have made it clear that the origin of ischemic heart disease (angina pectoris, ischemic myocardial necroses and fibroses, congestive heart failure) cannot be attributed to coronary vascular lesions alone. Augmentations of myocardial oxygen consumption under the dominating influence of the adreno-sympathogenic catecholamines, norepinephrine and epinephrine, contribute fundamentally to the metabolic vulnerability of the heart muscle. Discrepancies between limitations of compensatory coronary oxygen supply and catecholamine-induced incrcases of myocardial oxygen consumption lead to local anoxia and structural damage, especially in the vascularly handicapped left ventricular subendocardium. Over-civilized, prosperous, competitive, and sedentary living causes a detrimental sympathetic adrenergic preponderance in myocardial metabolism, both by emotional direct sympathetic stimulation and by a deterioration of antiadrenergic (vagal and sympathoinhibitory) counter-regulation, which results from lack of physical exercise. Nicotine contributes further to harmful catecholamine discharges. Emotion-induced overproduction of adrenal 17-hydro-xycorticoids may provide an additional aggravating factor. Objective criteria for the early recognition of cardiac ischemia-proneness, and preventive measures to avoid coronary atherosclerosis as well as neurogenic myocardial metabolic vulnerability are briefly discussed. The striking contrast between the incidence of ischemic heart disease in Japan and some Western countries deserves a systematic investigation concerning possibly co-responsible neurogenic and hormonal, emotional and physical activity factors beside the well-known dietary differences.
- 社団法人日本循環器学会の論文
- 1965-02-20