…be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome…

…tamponade from haemopericardium Myocardial ischaemia from coronary ostial compromise Focal neurological deficits or non haemorrhagic stroke Renal, mesenteric or lower limb ischaemia Paraplegia or paraparesis…

…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…

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…

…the type of stroke and the possibility of thrombolytic treatment. Cardiac and pulmonary complications Acute hypertension may precipitate myocardial ischemia or infarction, acute heart failure…

…Myocarditis and takotsubo syndrome can produce myocardial injury and troponin elevation but are non ischaemic mimics rather than MINOCA when identified as the final diagnosis…

…while chronic myocardial injury may be seen in heart failure, cardiomyopathies, and severe valvular heart disease. Type 2 MI and non ischaemic myocardial injury may…

…from non ischaemic cardiac conditions (such as myocarditis) or non cardiac conditions (such as renal failure). To establish a diagnosis of MI, acute myocardial injury…

…does not establish MI, because myocardial injury may occur without myocardial ischaemia. Non ischaemic myocardial injury may accompany numerous cardiac and systemic disorders, including: Cardiac…

…influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the myocardium and coronary microcirculation…

Myocardial ischemia and infarction Introduction Drug eluting stents (DES) are the predominant device used during percutaneous coronary intervention (PCI). They evolved from balloon angioplasty and…

…without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI), in which myocardial ischaemia is accompanied by cardiomyocyte necrosis…

…of ischaemia represents acute myocardial injury rather than MI. Persistent elevation without a significant dynamic change is consistent with chronic myocardial injury. Non ischaemic conditions…

…lead distribution [15]. Differential Diagnosis of ST Elevation Several nonischemic conditions can produce ST segment elevations that mimic acute myocardial infarction. Acute pericarditis is a…

…with ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (Non STEMI, NSTEMI) in detail. Although myocardial ischemia may affect every…

…imaging. Detecting ischemic regions requires provocation using pharmacologic agents or physical exercise. Pharmacologic agents include dipyridamole, adenosine, regadenoson, and dobutamine. Dobutamine increases myocardial oxygen demand…

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

…is stated that it is extremely uncommon to have a non ischemic ECG (absence of ST T changes) during chest pain caused by myocardial ischemia…

…Roll off phenomenon The roll off phenomenon in myocardial perfusion imaging, illustrated in Figure X, highlights the non linear relationship between tracer uptake and coronary…

…appears to act through a redistribution of blood from non ischemic to ischemic myocardium (i.e an increase in blood flow in the ischemic area…

…patients without ST segment elevations, urgent angiography is considered after resuscitation if there is a high probability of ongoing myocardial ischemia. IIa C Pre hospital…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the…

ECG Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms…

…system (Thrombolysis in Myocardial Infarction). Prasugrel should only be considered for patients at increased bleeding risk if the benefits of preventing ischemic events outweigh the…

…of infarcting myocardium early II trial substudy. Circulation. 2000 Oct 24;102(17):2031 7. The TIMI risk score for unstable angina/non ST elevation…

…pain patterns based on the provided context. Condition Typical Pain Quality/Location Key Modifying Factors Associated Physical/Clinical Clues ACS/Myocardial Ischemia Substernal discomfort, pressure…

…hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand, typically exercise…

…hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand, typically exercise…

…Consequently, current guidelines recommend a 3 generation family history and consideration of genetic testing for all patients with non ischemic HFrEF. Toxic and infiltrative causes…

…interspersed with surviving bundles of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy (NICM), hypertrophic cardiomyopathy (HCM)…

…overdoses, etc.). Among victims in whom the cardiac arrest was caused by VT or VF (e.g acute or chronic myocardial ischemia, heart failure, etc…

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…

…the appropriate clinical context. Unstable Angina presents with clinical and/or electrocardiographic signs of myocardial ischemia but lacks this biomarker elevation. With the ubiquitous adoption…

…involving patients with previous vascular disease, aspirin reduced the combined incidence of non fatal MI, non fatal ischaemic stroke, and vascular death from 8.2…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Fractional flow reserve (FFR) is an invasive, lesion specific physiological index used to estimate the functional significance…

…recognises that symptoms of myocardial ischaemia may arise from obstructive atherosclerotic CAD, coronary microvascular dysfunction or vasospasm. A normal or non obstructive coronary anatomy does…

…Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia may therefore remain undetected unless CT based coronary calcium assessment or another anatomical technique is added…

ECG Myocardial ischemia and infarction Classification, diagnosis and definitions of acute coronary syndromes (ACS) and acute myocardial infarction (AMI) Acute coronary syndromes occur when atherosclerotic…

…of myocardial ischemia and is particularly pronounced in patients experiencing acute STEMI. The severity of symptoms in STEMI patients, compared to those with Non ST…

…tracer uptake and associated myocardial changes: Mild defects : Characterized by decreased tracer counts while preserving normal wall thickness, often indicative of early or mild ischemia…

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…

…Myocardial infarctions affecting only the subendocardium are usually caused by subtotal coronary artery occlusions. This is discussed in detail in the chapter NSTEMI (Non ST…

Myocardial ischemia and infarction Definition and pathophysiological context Non ST segment elevation myocardial infarction (NSTEMI) is considered within the spectrum of non ST elevation acute…

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…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Dual antiplatelet therapy (DAPT) is the combined use of aspirin and an oral P2Y12 receptor inhibitor…

…myocardial rupture. Late presentation For patients presenting more than 12 hours after symptom onset, PPCI is recommended when there are: ongoing symptoms suggestive of ischaemia…

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…

…non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non…

…to the CTO is increased when non invasive testing demonstrates significant inducible ischaemia and preserved viability in the myocardial territory supplied by the occluded artery…

…patterns. Patients may present with: exertional angina or angina like chest discomfort; symptoms suggestive of myocardial ischaemia despite normal or non obstructive coronary arteries; dyspnoea…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Coronary artery calcium (CAC) scoring is a non invasive method for detecting and quantifying calcified coronary atherosclerotic…

Cardiology Myocardial ischemia and infarction Definition and Clinical Role Coronary computed tomographic angiography (CCTA) is a non invasive anatomical examination that depicts the coronary arterial…

…Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe, myocardial necrosis…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the…

…large epidemiological analysis, mechanical complications occurred in approximately 0.27% of STEMI cases and 0.06% of non ST elevation myocardial infarction cases. Despite their…

…defined by symptoms lasting more than 3 months and attributable to established reversible myocardial ischaemia in either of two settings: Obstructive coronary artery disease (CAD…

…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…

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

…chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy, the clinical presentation of ACS is generally similar to that in non pregnant patients, although…

…Ischaemia begins in the subendocardium, which contributes substantially to systolic wall thickening; consequently, inducible regional systolic wall thickening abnormalities may develop in the myocardial territory…