Fig. 3. Coronary microembolization and its consequences.
a | Rupture or erosion of an atherosclerotic plaque in an epicardial coronary artery releases particulate atherothrombotic debris and soluble substances into the coronary microcirculation. Debris causes physical obstruction of coronary microvessels, whereas soluble substances cause endothelial dysfunction, vasoconstriction and platelet aggregation. b | Microinfarcts occur in the myocardium accompanied by an inflammatory reaction, which impairs contractile function in adjacent surviving cardiomyocytes through signal transduction involving nitric oxide (NO), tumour necrosis factor (TNF), sphingosine, reactive oxygen species (ROS) and, ultimately, myofibrillar oxidation. Ab, antibody; l-NAME, NG-nitro-l-arginine methyl ester; NOE, N-oleoylethanolamine.