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Coronary Artery Disease: Regulation of Coronary Blood Flow

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Coronary Artery Disease

Part of the book series: Cardiovascular Medicine ((CVM))

Abstract

In the normal coronary circulation multiple redundant endothelium-independent and endothelium-dependent mechanisms act together to adjust blood flow in response to changing myocardial O2 requirements on a beat-to-beat basis. This metabolic vasoregulation is a function of the coronary arterioles which are responsive to the energetic state of the myocardium. Coronary arteries do not respond directly to myocardial metabolic needs, but dilate when increased blood flow produced by arteriolar dilation increases endothelial shear and triggers nitric oxide (NO) production. Atherosclerosis or risk factors for atherosclerosis cause endothelial dysfunction as a result of increased production of oxygen free radicals that consume NO and impair endothelium-dependent vasodilation. Stenotic lesions of the epicardial arteries impair vasodilator reserve and can result in exercise-induced myocardial ischemia or, if sufficiently severe, can reduce resting coronary flow to produce unstable angina or myocardial infarction. In the setting of occlusive coronary artery disease, growth of collateral vessels can provide an alternate blood supply to protect the dependent myocardium from ischemia.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Robert J. Bache MD

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  1. Robert J. Bache MD
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Correspondence to Robert J. Bache MD .

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Editors and Affiliations

  1. Cardiology Division, President, Texas Heart Institute, Houston, Texas, USA

    James T. Willerson

  2. Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    David R. Holmes, Jr.

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Bache, R.J. (2015). Coronary Artery Disease: Regulation of Coronary Blood Flow. In: Willerson, J., Holmes, Jr., D. (eds) Coronary Artery Disease. Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-2828-1_4

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  • DOI: https://doi.org/10.1007/978-1-4471-2828-1_4

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2827-4

  • Online ISBN: 978-1-4471-2828-1

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