The early clinical manifestations of acute myocardial ischemia, such as ST elevation and arrhythmias, are primarily driven by extracellular potassium accumulation rather than ATP depletion.
Extracellular K+ focus may refine early ischemia models; leaves open targeted interventions pending prospective validation.
The cellular events leading to clinical manifestations of acute (less than 30 minutes) ischemia are discussed, with emphasis on the role of early extracellular K+ accumulation and its effect on sodium current kinetics, which causes changes in excitability, conduction, and refractory periods. These are the cellular phenomena responsible for ST elevation, reentry, and enhanced automaticity, which characterize the early clinical events in ischemia. During this early period, ATP levels are normal and calcium metabolism appears normal.
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Fozzard et al. (1985) studied this question.
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