A Breakthrough in the Pathogenesis of Ischemic Heart Disease: the MINOCA and INOCA Challenge

Ricardo Esper, Juan Carlos Kaski

Abstract


Classical coronary syndromes as angina pectoris, ischemiaand myocardial infarction, which were describedmany years ago, are generally attributed tothe presence of different degrees of coronary arteryobstruction caused by atherosclerotic plaques.Atherosclerosis is a chronic inflammatory diseaseaffecting both sexes that starts in childhood, and evenin intrauterine life, and progresses throughoutthe years, especially in subjects with cardiovascularrisk factors. In this inflammatory process, and in thepresence of a specific or inadequate metabolic environments,such as diabetes mellitus or those resultingfrom traditional risk factors, β-lipoproteins and glycatedproteins oxidize becoming antigenic and causingendothelial dysfunction. This favors the penetrationof these molecules into vascular subendotheliallayers where they generate an immunogenic reaction,activating monocytes that are transformed into macrophages,which, together with other cells involved inthis process, create a lipid inflammatory core. Vascularsmooth muscle cells, recruited by inflammation,change from a contractile phenotype to a secretoryphenotype and generate collagen, which surroundsthe lipid inflammatory core and promotes calciumdeposition, completing the formation of the atheromatousplaque. This complex process (briefly describedhere) involves a multitude of molecules thatare produced as a result of oxidation, inflammation,apoptosis, angiogenesis, degradation of the fibrouscap, influx of red cells, tissue factor expression andother components that determine the progression ofthe atherosclerotic plaque over time.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar