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July 25, 1990

Stunned vs Hibernating Myocardium-Reply

Author Affiliations

University of Miami (Fla) School of Medicine

University of Miami (Fla) School of Medicine

JAMA. 1990;264(4):455-456. doi:10.1001/jama.1990.03450040043026

In Reply.—  Dr Gbur correctly points out the problem of nomenclature in describing a jeopardized myocardium that does not contract because of an ischemic or reperfusion insult. Based on experimental data, the rate of function recovery time is used retrospectively to segregate the "stunned" myocardium (postreperfusion) from the "hibernating" myocardium (caused by hypoperfusion).1 The two terms, at times, are used interchangeably because myocardial segments frequently contain jeopardized myocytes that may remain viable with adequate or inadequate perfusion.The dissociation between cardiac function, pathology, and reperfusion has been known for some time.2 It is seen daily in cardiac surgery patients, in whom myocardial "stunning," lasting from a few seconds to days, occurs after restoration of coronary perfusion. This is especially true in hearts after cardiac transplantation. As pointed out in my article, continued reperfusion (with high flow and pressure) remains the key factor in restoration of contractility in