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July 25, 1990

Stunned vs Hibernating Myocardium

JAMA. 1990;264(4):455. doi:10.1001/jama.1990.03450040043025

To the Editor.—  The recent review by Dr Bolooki1 on surgical management of complications of acute myocardial infarction should serve as a standard for treatment of these critically ill patients. However, the statement pertaining to postinfarction cardiogenic shock that "acute revascularization should result in immediate improvement in the function of the ischemic areas and of the 'stunned' myocardium" is somewhat misleading."Myocardial stunning" refers to transient postischemic contractile abnormalities seen after reperfusion has been restored.2 This phenomenon has been shown to last for up to several days. In contrast, "hibernating myocardium" refers to dysfunction of viable tissue as a result of prolonged, chronic hypoperfusion, which is completely reversible on restoring adequate blood flow.2,3 The jeopardized myocardium that Dr Bolooki discusses fits neither of these definitions. This most likely represents salvage of myocytes that have not been irreversibly damaged by the acute ischemic insult.These two terms are