How can a patient with advanced atherosclerosis, including a total coronary-artery occlusion, have normal cardiac function? The answer involves the complexities of the relation between coronary-artery anatomy and coronary physiology in ischemic heart disease. Total occlusion of a major artery with little or no detectable left ventricular injury is not an infrequent finding in patients undergoing catheterization for symptomatic disease. In such a circumstance the physiology of myocardial blood flow is a more important determinant of the fate of myocardium within the distribution of a given coronary artery than is the severity of the anatomic lesion. The paper by White.
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