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Thomas W. Moir, MD

Arch Intern Med. 1972;129(5):799-807.

Abstract
Coronary occlusion causes increased flow in adjacent arteries due to increased myocardial oxygen consumption in the area of the unoccluded arteries. Interarterial collateral circulation increases after coronary occlusion and is rapidly mobilized with repeat occlusion. There is some collateral flow from the cardiac cavities to the myocardium with coronary occlusion but this is via retrograde perfusion of venous drainage channels in the atria and right ventricle rather than directly from the left ventricular cavity. Endocardial distribution of coronary flow is equal to that of the epicardium in the normal or hypertensive left ventricle but the inner layers of the ischemic left ventricle show a marked restriction of flow. Coronary autoregulatory mechanisms are immediately mobilized by acute myocardial ischemia but the metabolic adenosine hypothesis appears unlikely to be the sole cause of the vasodilatory response.

Author Affiliations
Cleveland

From the Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland.

Footnotes
Received for publication Nov 1,1971; accepted Jan 28, 1972.

Reprint requests to University Hospitals of Cleveland, University Circle, Cleveland 44106 (Dr. Moir).

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ABSTRACT