What is myocardial necrosis?

Myocardial necrosis refers to the death of myocardial (heart muscle) cells due to inadequate blood supply, typically resulting from ischemia (restriction of blood flow) or infarction (complete blockage of blood flow). This condition is commonly associated with coronary artery disease, which occurs when the coronary arteries that supply blood to the heart become narrowed or blocked by atherosclerotic plaques.


The myocardium, or heart muscle, requires a constant supply of oxygen and nutrients provided by blood flow through the coronary arteries. When blood flow to a part of the myocardium is reduced or blocked, as in the case of a coronary artery occlusion, the affected area of the heart becomes ischemic, leading to cellular injury and death.


Myocardial necrosis can result in various clinical conditions, including:


  • Myocardial Infarction (Heart Attack): Myocardial infarction occurs when a coronary artery becomes completely blocked, usually by a blood clot, leading to prolonged ischemia and irreversible damage to the myocardium. The extent and severity of myocardial necrosis determine the severity of the heart attack and its clinical consequences.


  • Ischemic Heart Disease: Ischemic heart disease encompasses a spectrum of conditions characterized by reduced blood flow to the heart muscle, including stable angina (chest pain or discomfort during exertion), unstable angina (chest pain at rest or with minimal exertion), and myocardial infarction.


  • Acute Coronary Syndrome: Acute coronary syndrome refers to a group of conditions caused by sudden, reduced blood flow to the heart, including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These conditions are considered medical emergencies and require prompt evaluation and treatment.


  • Heart Failure: Chronic myocardial necrosis, particularly if it affects a large portion of the myocardium, can lead to impaired cardiac function and heart failure. Heart failure occurs when the heart is unable to pump blood effectively to meet the body’s demands, leading to symptoms such as shortness of breath, fatigue, and fluid retention.


What is the relationship between myocardial necrosis and oxidative stress?

The relationship between myocardial necrosis and oxidative stress involves complex interactions between ischemia-reperfusion injury, inflammation, and cellular damage. When blood flow to the myocardium is compromised, as in the case of myocardial infarction (MI) or ischemic heart disease, it leads to ischemia (restriction of blood flow) and subsequent tissue damage. During reperfusion, when blood flow is restored to the ischemic tissue, oxidative stress can occur due to the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) within the myocardium. Several mechanisms contribute to the generation of oxidative stress during myocardial necrosis:


  • Ischemia-Reperfusion Injury: Ischemia-reperfusion injury is a major contributor to oxidative stress in myocardial necrosis. During ischemia, there is an imbalance between oxygen supply and demand in the myocardium, leading to cellular hypoxia and metabolic dysfunction. Upon reperfusion, the sudden influx of oxygen-rich blood to the ischemic tissue can lead to the production of ROS and RNS through various pathways, including the mitochondrial electron transport chain, NADPH oxidase activation, and xanthine oxidase activity. The excessive generation of ROS and RNS during reperfusion can overwhelm endogenous antioxidant defenses and cause oxidative damage to cellular components, including lipids, proteins, and DNA.


  • Inflammatory Responses: Myocardial necrosis triggers inflammatory responses within the myocardium, involving the recruitment and activation of immune cells such as neutrophils, macrophages, and lymphocytes. Inflammatory cells produce ROS and RNS as part of their antimicrobial defense mechanisms, contributing to oxidative stress and tissue injury. Inflammatory cytokines and chemokines released during myocardial necrosis can further amplify oxidative stress by activating NADPH oxidase and promoting ROS production by immune cells.


  • Mitochondrial Dysfunction: Ischemia-reperfusion injury can lead to mitochondrial dysfunction and impairment of mitochondrial respiration, resulting in increased ROS production by the electron transport chain. ROS generated within mitochondria can further exacerbate oxidative stress and contribute to cellular damage and apoptosis in the myocardium. Mitochondrial ROS production is particularly prominent during reperfusion, when oxygen levels are restored to the ischemic tissue.


  • Activation of Cell Death Pathways: Oxidative stress can activate apoptotic and necrotic cell death pathways in the myocardium, leading to further tissue damage and myocardial necrosis. ROS and RNS can induce mitochondrial permeability transition pore (MPTP) opening, cytochrome c release, and caspase activation, culminating in apoptotic cell death. Additionally, oxidative stress can trigger necrotic cell death through mechanisms such as lipid peroxidation, protein oxidation, and DNA damage.


Overall, oxidative stress plays a central role in the pathogenesis of myocardial necrosis by promoting tissue injury, inflammation, and cell death in the ischemic myocardium.