Clinical Significance of Collateral Blood Vessels

Special clinical conditions of the heart create collaterals, primarily myocardial ischemia, hypertension, cardiac hypertrophy or atherosclerosis. The aim of the paper was to show the importance of collateral vessels in clinical practice, particularly in the rehabilitation of coronary heart disease. The paper presents a case report of a patient 62 years old, anesthesiologist, who came for examination because of the pain in the shoulder, discomfort in the chest and pronounced fatigue with a sense of shortness of breath. Prior to these problems, he was extremely physically active (cultivated three hectares of land every day). Submaximal exercise test was negative, while the coronarography found 100% occlusion of the right coronary artery (RCA), while the left coronary artery (LCA) was characterized by adequate patency. Collateral blood vessel were labelled as welldeveloped. Risk factors: active smoker, elevated cholesterol values and dyslipidemia, positive heredity. Another risk factor was exposure to stress. Ten years later, a new assessment of coronary artery disease was performed due to marked fatigue and arrhythmias. On the stress test ECG, bigeminy was detected. As previously, coronarography showed 100% occlusion of RCA, with 30% narrowing of LCA. Echocardiographic findings of the heart were regular. Angiogenesis occurs under the influence of adenosine in hypoxic conditions, when stenosis must be at least 70% and is influenced by EDRF. Collateral blood vessels are of great importance in the pathophysiology and prognosis of coronary artery disease and myocardial infarction. Owing to the collateral, the same changes in the angiogram of large coronary blood vessels do not give the same electrocardiographic and clinical presentation. Well-developed collateral circulation prevents the spread of necrosis, and serious damage due to collagen formation after myocardial infarction. Speed and level of collateral development depends on the degree of stenosis and time of exposure to ischemia. The development of collateral blood vessels is probably genetically predetermined.