The Etiopathogenesis of Coronary Heart Disease ─ A Heretical Theory Based on Morphology

Progressing from the study of coronary collaterals through to the examination of congestive heart failure, Baroldi (pathological anatomy, U. of Milan, Italy) and Silver (laboratory medicine and pathobiology, U. of Toronto, Canada) present a defense of their currently unorthodox methodological approach to coronary disease, which stresses the demonstration of dysfunction through morphological findings, rather than just with clinical imaging. Among the "heretical" findings of their research: coronary collaterals exist and compensate sever atherosclerotic stenoses, atherosclerosis is due to increased hemodynamic stress in the vessel wall secondary to myocardial dysfunctions and increased peripheral resistance, myocardial necrosis is a collection of distinct forms of myocardial injury each with its own etiopathogenesis, and morpological data support the idea that coronary heart disease is more an adrenergic stress-dependent disease than a hydraulic problem. Annotation c2004 Book News, Inc., Portland, OR (booknews.com)