Gorlin R
Major Probl Intern Med. 1976;11:116-48.
The consequences of ischemia for the affected myocardium are highly variable. As a result, in chronic coronary heart disease there is little correlation between coronary arterial obstruction and myocardial dysfunction. Dysfunction can be permanent and related to replacement fibrosis or fixed disruption of the chain of events leading to effective contraction. Dysfunction can also be transient, as a direct consequence of acute myocardial ischemia. The mechanical lesions include generalized and localized myocardial dysfunction, mitral incompetence, and rarely, a left-to-right shunt through loss of integrity of the interventricular septum. Diagnosis per se is not difficult, but deciding on the true contribution of any given lesion to the overall symptoms and disability of the patient is. Therapy must be individually planned according to the total set of factors in each patient.
缺血对受影响心肌的后果差异很大。因此，在慢性冠心病中，冠状动脉阻塞与心肌功能障碍之间几乎没有相关性。功能障碍可能是永久性的，与替代性纤维化或导致有效收缩的事件链的固定破坏有关。功能障碍也可能是短暂的，是急性心肌缺血的直接后果。机械性病变包括广泛性和局限性心肌功能障碍、二尖瓣关闭不全，很少见的是由于室间隔完整性丧失导致的左向右分流。诊断本身并不困难，但确定任何特定病变对患者整体症状和残疾的真正影响却很困难。治疗必须根据每个患者的所有因素进行个体化规划。
