Cardioprotection by ACE inhibitors in myocardial ischaemia/reperfusion. The importance of bradykinin.

Myocardial ischaemia, when severe and sustained for more than 40 minutes, results in irreversible damage, i.e. myocardial infarction. However, with early reperfusion, damage is reversible. Complete recovery of contractile function requires some time, despite fully or almost fully restored blood flow. This phenomenon has been termed myocardial stunning. There is experimental evidence showing that angiotensin converting enzyme (ACE) inhibitors limit the development of infarct size, reduce the incidence of ischaemic and reperfusion arrhythmias, and enhance the recovery of contractile function of stunned myocardium. These cardioprotective effects of ACE inhibitors are mediated by an attenuated degradation of bradykinin.