With the re-emergence of surgery on a beating heart, it is important to examine the unique phenomenon of ischemic preconditioning (IPC) and its role as a form of myocardial protec tion under these circumstances. Ischemic preconditioning is defined as a short period of ischemia, regional or global, imposed before a more prolonged period of ischemia, which increases the myocardium's tolerance to ischemia by endogenous adaptive mechanism. 1 Until recently, it was generally held that repeated ischemic episodes would have a cumu lative adverse effect and could lead to a "stuttering infarction."
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