Which statement best distinguishes myocardial hibernation from myocardial stunning?

• A Hibernation follows reperfusion and recovers spontaneously within days, while stunning persists until revascularisation
• B Stunning occurs only in non-atherosclerotic coronary spasm, whereas hibernation requires complete coronary occlusion
• C Both conditions represent irreversible myocyte loss detectable as fixed perfusion defects on scintigraphy
• D Hibernation is chronic hypoperfusion with downregulated contractile function that improves after revascularisation, while stunning is transient dysfunction after a brief ischaemic episode followed by reperfusion ✓

Explanation

Hibernation is an adaptive response to chronic low-grade ischaemia: viable myocytes reduce contractile activity to match reduced supply, and function recovers once flow is restored by revascularisation. Stunning is prolonged but reversible post-ischaemic dysfunction after a transient episode with reperfusion, recovering spontaneously over time. Both states involve viable myocardium, so neither produces a fixed perfusion defect or scar.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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