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Changing Perspectives: The resurrection of intramyocardial haemorrhage

The resurrection of intramyocardial haemorrhage

A phenomenon which has been buried for decades, is now more alive than ever: intramyocardial haemorrhage.

A phenomenon which has been buried for decades, is now more alive than ever: intramyocardial haemorrhage. Nowadays, timely reperfusion through percutaneous coronary intervention has become the mainstay of treatment in patients with acute myocardial infarction, leading to significantly improved survival. Obviously, this has not always been the case. In the 1960s, in the early days of thrombolytic therapy, scientists discovered in animal models that reperfusion of an occluded coronary artery resulted in destruction of the microvasculature, and consequently severe bleeding inside the myocardium which they called ‘intramyocardial haemorrhage’. This was ascribed to the effects of thrombolytics and its occurrence in patients was assumed as clinically insignificant.

Now, 50 years later, modern imaging techniques have shown that in approximately one-third of all patients treated with percutaneous coronary intervention, intramyocardial haemorrhage still occurs and is clinically important. Intramyocardial hemorrhage is now seen as a major contributor to non-reperfusion of myocardial tissue, giving rise to wall motion abnormalities, heart failure, and increased mortality risk. Therefore, future treatment strategies should aim at protecting microvascular destruction, in order to bring intramyocardial haemorrhage back to its grave.

Read more about intramyocardial haemorrhage in Betgem et al., Nature reviews cardiology 2014

R. Betgem & W. Li

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