…stents (DES) are the predominant device used during percutaneous coronary intervention (PCI). They evolved from balloon angioplasty and bare metal stents (BMS) in response to…

…chronic coronary syndrome (CCS), acute coronary syndrome (ACS), myocardial infarction, and repeat target lesion revascularization. Restenosis after balloon angioplasty differs mechanistically from ISR. Balloon angioplasty…

…future plaque rupture. Anatomical severity versus functional significance The physiological effect of a coronary lesion depends on more than its visual diameter reduction. Relevant determinants…

…bridging is an anatomical variant in which a segment of an epicardial coronary artery passes through the myocardium rather than remaining on the epicardial surface…

…In contrast, coronary CT angiography (CCTA) can characterize both calcified and non calcified plaque and can assess stenosis. A major limitation is that CAC does…

…15 seconds, with submillimetre spatial resolution. Iodinated contrast is generally required for coronary angiography because the intrinsic contrast between the cardiac chambers, blood pool, and…

…managed as a distinct clinical entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during…

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…

…including transitions between stable angina, angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), post ACS or post revascularization states, and heart failure of…

…in selected patients, identifying microvascular or vasomotor coronary disorders. The investigation should be undertaken when its diagnostic or therapeutic consequences are likely to outweigh procedural…

…is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography…

…and angina related health status, and both can reduce myocardial ischaemia during exertion or emotional stress. Neither procedure, however, reverses the underlying coronary atherosclerotic process…

…approximately 40–50 years. Hormonal influences, including oestrogen and progesterone related structural changes in the coronary media. The early postpartum period, when marked hormonal changes…

…managed as a distinct clinical entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during…

…Figure 1. The coronary arteries and their relation to the ECG leads. Localization of myocardial infarction / ischemia is done by using ECG changes to determine…

…and procedural complexity. Overall incidence and major complications Complications during diagnostic coronary angiography occur in approximately 2% of patients. Serious events such as stroke and…

…than a more distal lesion. Revascularisation improves myocardial blood flow and angina related health status but does not reverse coronary atherosclerosis. Long term benefit therefore…

…infarction Classification, diagnosis and definitions of acute coronary syndromes (ACS) and acute myocardial infarction (AMI) Acute coronary syndromes occur when atherosclerotic plaques disrupt, resulting in…

…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…

…in these regions. Mortality rates and case fatality in coronary artery disease peaked in the 1970s and have declined steadily ever since. The marked decline…

Abstract Angiographic stenosis severity is a poor surrogate for the hemodynamic significance of a coronary lesion, with anatomic and functional assessment discordant in a substantial…

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

…dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic status, coronary anatomy, comorbidities, procedural complexity, age…

…inhibition therefore provides complementary platelet inhibition. The clinical rationale for DAPT is particularly strong after ACS and coronary stent implantation. ACS is associated with a…

…a definitive disease diagnosis. It is a descriptive and provisional classification that should trigger further investigation. The underlying mechanism may be coronary, myocardial, or systemic…

…for routine use. No reflow may also occur in association with other procedural complications, including distal embolization, coronary dissection, perforation, and abrupt closure. The clinical…

…5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients with acute coronary syndrome…

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…

…Figure 1A. The coronary arteries and their relation to the ECG leads. Localization of myocardial infarction / ischemia is done by using ECG changes to determine…

Cardiology Principles of myocardial perfusion imaging Myocardial perfusion imaging (MPI) is a non invasive technique for detecting and quantifying coronary artery disease (CAD). It offers…

…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…

…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…

…and a small lipid core, the pathophysiology of Acute Coronary Syndromes (ACS) is driven by the sudden destabilization of these lesions, a process known as…

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…

CPR Sex : Male Age : 62 years History : Coronary bypass grafting; history of arrhythmias. Medications : beta blockers ECG 1 . Sinus rhythm interrupted by ventricular tachycardia (VT…

CPR The forces that drive coronary and cerebral perfusion, and ventilation of the lungs during cardiopulmonary resuscitation (CPR) differ substantially from normal circumstances. The purpose…

…standardized method to evaluate the anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…

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…

Cardiology Indications for myocardial perfusion imaging Diagnosis of coronary artery disease (CAD) : Myocardial perfusion imaging can confirm or rule out CAD in patients with symptoms…

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…

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

…and infarction Pharmacology & dosing Definition and therapeutic objectives Antianginal therapy in chronic coronary syndrome (CCS) is directed primarily at reducing myocardial ischaemia and relieving anginal…

…Objective evidence of myocardial ischaemia. Absence of obstructive coronary artery disease, defined as no stenosis exceeding 50% diameter reduction and/or an FFR 0.80…

…stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque…

…ischemia and infarction Definition and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion…

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…

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

Myocardial ischemia and infarction Definition and Pathophysiology Intravascular imaging comprises catheter based techniques that directly visualize the coronary lumen, vessel wall, plaque, thrombus, and implanted…

…myocardial tissue whose contractile function improves after coronary revascularization. This functional definition encompasses several physiological states. Brief coronary occlusion or relatively prolonged moderate ischemia may…

…is more likely with extensive myocardium at risk, severe baseline stenosis, multivessel coronary artery disease, or diffuse disease. No reflow represents impaired antegrade myocardial perfusion…

…patients with a high probability, testing may add little diagnostic value and invasive coronary angiography may be more appropriate when symptoms, risk or anatomical considerations…

…and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with…

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…

…is the most severe complication of coronary artery disease. The most common initiating mechanism is rupture or erosion of a vulnerable (unstable) atherosclerotic coronary plaque…

…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…