PROTECTION OF THE MYOCARDIUM BY ISCHEMIC PRECONDITIONING - MECHANISMSAND THERAPEUTIC IMPLICATIONS

Preconditioning of the heart with brief periods of ischaemia protects the myocardium for up to 90 min against a more sustained ischaemic inj ury. A ''second window of protection'' occurs 24 hr after precondition ing with ischaemia. The cardioprotective effects of ischaemic precondi tioning involve the release of mediators (adenosine, bradykinin, catec holamines, prostaglandins, endothelin-1), which either alone or in con cert activate protein kinase C, which translocates to the cell membran e. This manuscript reviews (i) the cardioprotective effects of ischaem ic preconditioning, (ii) the underlying mechanisms, (iii) the effects of ischaemic preconditioning of other tissues (skeletal muscle, brain and kidney), and (iv) the clinical implications.