Myocardial oxygen extraction is maximum at rest and cannot be increased further during times of stress. The only way to increase oxygen availability to the myocardium is to increase coronary perfusion and to maximize oxygen carrying capacity. Circulating hemoglobin is responsible for the body’s oxygen carrying capacity. Low hemoglobin will severely compromise oxygen carrying capacity. Decreased diastolic BP will critically decrease coronary perfusion pressure and myocardial blood flow. The combination of these two conditions would produce decreased oxygen delivery and produce an environment in which demand-induced ischemia would develop.
Low hemoglobin medical expert witness specialties include internal medicine, pediatrics, hospitalist medicine, pediatric hospitalist medicine, anesthesiology, hematology, and family medicine.