…Myocardial ischemia and infarction Definition and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall…

…the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty was initially limited…

…not delay reperfusion. 5. Give aspirin if acute coronary syndrome is likely and aortic dissection or active major bleeding is not suspected. 6. Call the…

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

…distal embolization, coronary dissection, perforation, and abrupt closure. The clinical consequences depend heavily on the amount of viable myocardium supplied by the affected artery. Large…

…follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may be relatively painless compared with those with spontaneous dissection. Clinical manifestations may…

…with a calcified nodule. Epicardial or microvascular coronary spasm. Spontaneous coronary artery dissection. Coronary embolism of cardiac or non cardiac origin. Oxygen supply–demand mismatch…

…or pericarditis Acute aortic dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe…

…use Deceleration injury Systemic hypertension coexists in approximately 70% of patients with aortic dissection. PAU is particularly associated with advanced age, smoking, coronary artery disease…

…from acute compromise of coronary flow. Mechanisms include: Coronary dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft…

…OCT or IVUS may demonstrate plaque rupture, thrombus, spontaneous coronary artery dissection (SCAD), or another occult structural abnormality. IVUS IVUS generates images by transmitting ultrasound…

…and proximal aorta can cause stroke, TIA (transient ischemic attack), coronary artery occlusion, and peripheral embolization. Stroke is the third leading cause of death in…

…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…

…is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and…

…Left main coronary artery stenosis Severe electrolyte imbalance Severe hyperthyroidism Moderate to severe aortic stenosis Insufficiently controlled arrhythmias which may cause hemodynamic compromise Obstructive hypertrophic…

…volume load, myocardial wall stress and coronary artery perfusion. These changes gradually lead to insufficient coronary perfusion (i.e myocardial ischemia and angina pectoris), ventricular…

…severe cases, there can be a rupture of the atria or ventricles. Myocardial infarction : The contusion can cause coronary artery dissection, atherothrombosis or rupture, resulting…

…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…

…hence the term subendocardial infarction ). Myocardial infarctions affecting only the subendocardium are usually caused by subtotal coronary artery occlusions. This is discussed in detail in…

…tracer uptake plateaus. This saturation effect can lead to an underestimation of blood flow in regions affected by significant coronary artery disease, potentially resulting in…

…Their duration is short; they typically disappear within minutes after a total occlusion in a coronary artery occurs (then of course, the ST segment will…

…in other situations than does ventricular rhythm; idioventricular rhythm is primarily seen after reperfusion in an occluded coronary artery. It also occurs as side effect…

…a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for individuals without known clinical coronary artery disease, especially when…

…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…

…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…

…manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures. Both can improve coronary flow, exercise capacity and…

…main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies the left anterior descending and left circumflex coronary…

…of the left main coronary artery (LMCA) abruptly interrupts blood flow to both the left anterior descending (LAD) and left circumflex (LCx) coronary artery territories…

…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…

…myocardial infarction and the coronary occlusion Determining the localization of myocardial infarction and ischemia, as well as identifying the occluded coronary artery and the location…

…aorta and pulmonary artery A slit like orifice A high origin Acute angle take off An intramural course, including its length Coronary Arterial Segments and…

…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…

… planned surgery, especially carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), or major non cardiac surgery. The vascular examination should include: palpation of peripheral pulses…

…course can impair coronary perfusion, particularly during vigorous exercise. In AAOCA, high risk anatomical features include an interarterial course between the aorta and pulmonary artery…

…to determine the affected area and subsequently the occluded coronary artery (culprit). Figure 2 shows the coronary arterial territories in relation to the 17 segments…

…also influenced by anatomic complexity and comorbidity, which themselves may contribute to progression of native coronary artery disease. The chronic total occlusion is an important…

…vascular structures is limited. CCTA has become an important first line investigation for selected patients with suspected coronary artery disease (CAD), particularly those with stable…

…than 70%, and are an important reason that patients are referred for coronary artery bypass grafting rather than percutaneous coronary intervention (PCI). A CTO may…

Cardiology Clinical medicine Definition and pathophysiology Peripheral artery disease (PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying…

…for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when appropriate, immediate percutaneous coronary intervention (PCI)…

…acute coronary syndrome or guide percutaneous coronary intervention (PCI). ICA therefore has three principal roles: Defining the anatomical distribution and severity of epicardial coronary artery…

…Figure 1. Flowchart showing the natural course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG…

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…

…revascularization itself in stable coronary artery disease, while a distinct evidence base has emerged for coronary microvascular and vasospastic disease using coronary flow reserve (CFR…

…and angiographic findings. OMI is defined by acute coronary artery occlusion causing transmural ischemia and requiring urgent reperfusion, even in the absence of classic ST…

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…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

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…

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

…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…

…low likelihood of obstructive CAD and may reduce unnecessary diagnostic testing. Coronary artery calcium (CAC) provides additional information. A quantitative CAC score from dedicated testing…

…efficacy as compared with nicardipine. Labetalol is safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen…

…exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy…

…heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD), and after acute coronary syndromes in patients with reduced left ventricular ejection fraction…

…ischaemic electrocardiographic changes during rapid AF. ST segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material…

…consequent excess risk of premature atherosclerotic cardiovascular disease (ASCVD), particularly coronary artery disease (CAD). FH results from pathogenic variants affecting proteins in the hepatic LDL…

…the past century. Initial post mortem observations in the late 19th century first linked thrombotic occlusion of a coronary artery with myocardial necrosis. Although early…

…be considered. Effective lipid lowering improves survival and reduces cardiovascular mortality in patients with coronary artery disease irrespective of the baseline cholesterol concentration. Intensive statin…

…disability and premature mortality. Cardiovascular conditions associated with obesity include hypertension, dyslipidaemia, coronary artery disease (CAD), atherosclerosis, heart failure (HF), atrial fibrillation and cardiovascular events…