Coronary artery disease is a major cause of morbidity and mortality in the Western world. Acute myocardial infarction, resulting from coronary artery atherosclerosis, is a serious and often fatal consequence of coronary artery disease, resulting in cell death in the myocardium. Pre-and postconditioning of the myocardium are two treatment strategies that reduce the amount of cell death significantly. Hydrogen sulfide has recently been identified as a potent cardioprotective signaling molecule, which is a highly effective pre-and post-conditioning agent. The cardioprotective signaling pathways involved in hydrogen sulfide-based pre-and post-conditioning will be explored in this article.
Keywordsacute myocardial infarction; apoptosis; ischemia/reperfusion injury; myocardial protection; oxidative stress Acute myocardial infarction (AMI) is a serious and often fatal consequence of coronary artery disease. With AMI, the best course of action to limit myocardial infarct size is a timely restoration of blood flow to the ischemic myocardium by either thrombolysis or percutaneous angioplasty [1,2]. Unfortunately, the blockage is rarely recanalized before a considerable amount of damage is done to the myocardium, subsequently leading to persistent heart failure in a large percentage of patients [1,2].Pre-and post-conditioning and pharmacological treatments to mimic these interventions have been shown to be effective in limiting infarct size in the setting of myocardial ischemia/reperfusion (MI/R) injury in both animals and humans [3]. When coupled with timely reperfusion, pre-and post-conditioning attenuate myocardial infarct size and postischemic left ventricular dysfunction more than reperfusion alone [3]. Both pre-and post-conditioning can be achieved in numerous ways to induce physiological changes that result in increased cytoprotection after reperfusion of the ischemic heart [3].