Energy metabolism in the normal and diseased heart

Abstract

This chapter reviews the metabolic pathways involved in transferring the chemical energy stored in dietary carbon substrates (primarily glucose and fatty acids) into adenosine triphosphate (ATP) and the regulatory systems that integrate the functions of these pathways and make them responsive to changes in energy demand. Normal cardiac function depends upon both the adequate delivery of carbon substrates and oxygen to the heart by the coronary circulation and the ability of the heart to extract and metabolize these substrates at rates sufficient to support a wide range of ATP demands. The effects of several physiological states and disease processes on cardiac metabolism are also discussed and the concept that the diseased heart may be energy limited is presented. Lastly, an example of a new therapeutic approach, based on a detailed understanding of an inherited metabolic pathway abnormality, emphasizes the importance of detailed knowledge of energetic pathways. © 2009 Humana Press.