Abstract: Constriction of intramural perforating vessels would induce dynamic episodes of significant myocardial ischemia in patients with atherosclerotic epicardial coronary arteries. Ventricular hypertrophy, both as a primary cardiomyopathy of unknown etiology and also as a secondary consequence or reaction to sustained arterial hypertension or aortic stenosis, would promote ischemia of the myocardium due to compromised blood flow in ventricular perforating intramural vessels. Cyclical episodes of ischemia would progress on contraction of the hypertrophied left entricle. Dynamic contractility and viability of the myocardium appear primarily influenced by an inherently highly variable transmural blood flow, with induced ischemic episodes during systole. Cyclical myocardial ischemia would progress largely as a parametric function of systolic and diastolic contractility and rhythmicity, which determine, in turn, dynamics of blood flow delivery through perforating vessels in the left ventricular wall.