…producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material. Superficial plaque erosion. Thrombosis associated with a calcified nodule. Epicardial or microvascular coronary…

…by epicardial vasomotor dysfunction or microvascular abnormalities without obstructive epicardial disease. The non acute phase after ACS or coronary revascularization. Non acute heart failure in…

…obstruction. In patients with anginal symptoms and unobstructed or non obstructive coronary arteries, possible mechanisms include microvascular obstruction, endothelial dysfunction and epicardial coronary spasm. The…

…despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography…

…platelet rich thrombus. Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe…

…Endothelial dysfunction, coronary microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary…

…also by the vulnerability of the myocardium and coronary microcirculation. Endothelial dysfunction promotes leukocyte and platelet activation and interaction. Thrombotic debris may worsen microvascular obstruction…

…of angina may differ between patients. Myocardial ischaemia may result predominantly from obstructive epicardial coronary disease, coronary vasospasm, microvascular dysfunction, or combinations of these mechanisms…

…coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection…

…or ventricular tachycardia. Prolonged spasm can cause acute myocardial infarction, including myocardial infarction with non obstructive coronary arteries (MINOCA). Ventricular fibrillation and sudden cardiac death…

…that angiographic blood flow does not always correlate with myocardial perfusion on the microvascular level. This is presumably explained by distal microembolization and dysfunctional microcirculation…

…quality of tissue level perfusion after epicardial flow is restored. Microvascular obstruction may persist despite successful PCI because of endothelial dysfunction, leukocyte and platelet interaction…

…Mechanism or clinical setting Examples Acute coronary atherothrombosis Plaque disruption or erosion with thrombosis Reduced myocardial perfusion Coronary spasm, microvascular dysfunction, coronary embolism, coronary dissection…

…device therapy eligibility. Ischemic cardiomyopathy, defined by significant CAD (prior MI, diffuse microvascular dysfunction, or flow limiting epicardial stenoses), is the predominant cause, accounting for…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…despite the absence of a flow limiting epicardial coronary stenosis. It is therefore a disorder of coronary microvascular perfusion rather than persistent obstruction of the…

…including chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD…

…all ischemic episodes are asymptomatic (refer to The Ischemic Cascade). Acute coronary syndromes occur when atherosclerotic plaques rupture or erode, leading to atherothrombosis and occlusion…

Kardiologi Akutsjukvård Lathundar Overview Acute coronary syndrome comprises STEMI, NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

ECG Introduction The traditional classification of acute coronary syndromes (ACS) into ST segment elevation myocardial infarction (STEMI), non STEMI (NSTEMI), and unstable angina (UA) has…

…ACS is the acronym for Non ST Elevation Acute Coronary Syndrome. This category includes all acute coronary syndromes without significant ST segment elevations on ECG…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly…

…the onset of myocardial infarction. This is utilized in clinical practice by detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed…

…or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI)…

…intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS), myocardial infarction (MI)…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Atherosclerosis and acute coronary syndromes have important inflammatory components. Inflammation contributes to atherothrombosis through activation of…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively…

…the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction)…

…occlusion, likely because most such occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic process is dynamic, with…

…and minor access site bleeding to myocardial infarction, stroke, coronary perforation, haemodynamic collapse, acute kidney injury, and death. The risk profile differs between diagnostic angiography…

…It is also an alternative to invasive coronary angiography (ICA) for excluding non ST segment elevation acute coronary syndrome (NSTE ACS) in patients with a…

…exercise tolerance Acute coronary syndrome Silent ischaemia Heart failure, particularly when left ventricular function is impaired Haemodynamic or electrical instability in advanced or acute presentations…

…multivessel CAD varies from stable angina or exertional limitation to acute coronary syndrome (ACS), ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease…

…progressive disease. NSTE ACS (Non ST Elevation Acute Coronary Syndrome) : NSTE ACS is an acute condition that occurs when an atherosclerotic plaque ruptures, which causes…

…coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute chest and/or back…

…the risk is low. In patients undergoing percutaneous coronary intervention, even mild baseline renal dysfunction is associated with worse outcomes. The risk of death at…

…Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty was initially limited by acute vessel closure and later restenosis. Coronary stents provided a scaffold that…

…progressive disease. NSTE ACS (Non ST Elevation Acute Coronary Syndrome) : NSTE ACS is an acute condition that occurs when an atherosclerotic plaque ruptures, which causes…

…a high coronary origin, acute angle take off, and an intramural course. An anomalous left coronary artery is less common but more malignant than an…

…and occlude. Many acute myocardial infarctions arise from lesions that previously obstructed less than 50% of the lumen. Assessment of total coronary disease burden, including…

Kardiologi Akutsjukvård Lathundar Key message The distinction that determines management is: is there acute hypertension mediated organ damage or not? A single blood pressure value…

…pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However, association is not the same…

…Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS (NSTEMI…

…improved when they were treated as acute STEMI cases. Management of left bundle branch block (LBBB) in patients with acute coronary syndromes (ACS) For many…

Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

…progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental pathophysiological substrate for acute coronary syndromes (ACS), including…

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

ECG Myocardial ischemia and infarction Non ST Elevation Acute Coronary Syndromes (NSTE ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus…

…changes and clinical implications is provided. The reader should already be familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST…

ECG Myocardial ischemia and infarction Acute myocardial infarction (AMI) always affects the left ventricle Myocardial infarction is virtually synonymous with left ventricular infarction . All myocardial…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

…with increased risk of hypotension in patients with autonomic dysfunction, hypovolemia, or severe coronary or valvular disease Recent (<48 hours) use of dipyridamole or dipyridamole…

…threatening ventricular arrhythmias in the acute phase. Ventricular tachycardia (VT) and ventricular fibrillation (VF) may occur at any time after occlusion of the coronary artery…

…Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in…

…problem worldwide. While the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the…