The mechanism of myocyte death in ischaemia.

Mechanisms of myocyte cell death in severe ischaemia may include: (1) accumulated metabolic products; (2) activation of membrane phospholipases; (3) formation of oxygen-derived free-radicals; (4) infiltration by activated neutrophils; (5) increased circulating catecholamines; (6) cytosolic calcium overload; (7) an inadequate supply of glycolytically produced ATP. The hypothesis is proposed that failure of glycolysis leads to inadequate control of intracellular calcium, which is a lethal event. This hypothesis would explain the concept that in the hibernating myocardium, viable zones can be detected by positron emission tomography of fluoro-deoxyglucose.