…left coronary cusp (LCC), and noncoronary cusp (NCC), showing the same branches as in panel A for cross modality comparison. Clinical features Occlusion of the…

…alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing ECG signs of right ventricular involvement is…

…hypertension with or without left ventricular hypertrophy. Among patients with NSTE ACS undergoing angiography, approximately 10% have no critical epicardial stenosis. In some of these…

…a cerebral artery is occluded due to local atherothrombosis or occlusion due to embolization. Approximately 30% of all ischemic strokes are caused by cardiac embolism…

…a proximal occlusion (in the RCA) which cuts off blood flow to the right ventricle, will also affect the inferior wall of the left ventricle…

…in the leads with the highest ST segment elevation. Figure 2. The electrocardiographic natural course in STEMI (ST elevation myocardial infarction). Inversion of T waves…

…occur when atherosclerotic plaques rupture or erode, leading to atherothrombosis and occlusion. This causes severe ischemia and the vast majority of patients experience angina pectoris…

…abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood…

…Additional features associated with greater difficulty include a previously failed attempt, a blunt proximal stump, vessel bending, calcification and an occlusion length of at least…

…NSTEMI) since they present with ST segment depressions on the 12 lead ECG (recall that ST segment depression is the hallmark of NSTE ACS/NSTEMI…

…and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction…

…vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left ventricular…

…occur simultaneously (if both territories are affected by the same artery occlusion). Approximately 30% of patients with posterolateral infarction will also have right ventricular infarction…

…of patients with pulmonary embolism or deep vein thrombosis experience a second thrombotic event within 10 years ( Goldhaber et al, Kearon et al ). Epidemiology of…

…Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents, gun violence, threats, or any situation in which the…

…and degree of myocardial involvement The anatomical territory, including anterior, inferoposterolateral or right ventricular involvement Pre existing abnormalities such as prior infarction, left bundle branch…

…a 60 minute occlusion of the left anterior descending coronary artery (LAD) would reduce the infarct size by 60%, as compared with directly occluding the…

…patients with acute coronary syndromes is permeated by the mantra time is myocardium, which refers to the progressive loss of myocytes following the occlusion of…

…objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic…

…coronary occlusion or relatively prolonged moderate ischemia may produce post ischemic stunning. In the absence of infarction, contractile recovery can occur rapidly after reperfusion, with…

…of upsloping ST segment depressions with prominent T waves in the majority of the chest leads may indicate an acute occlusion in the LAD (left…

…tunica adventitia , respectively. Figure 1. Layers of the left ventricular wall, pericardium and ventricular cavity. The endocardium The endocardium lines the atria, ventricles and the…

…coronary artery occlusions, and outcomes improved when they were treated as acute STEMI cases. Management of left bundle branch block (LBBB) in patients with acute…

…anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables, including the number of lesions…

…left atrial appendage . Such thrombi may leave the appendage and enter the systemic circulation which causes thromboembolic occlusions of arteries in the brain, limbs or…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions and/or T…

…waves) do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead…

…Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes, occurring before cTn values become available or abnormal…

…subepicardium over several hours. The extent and tempo of injury are influenced by collateral flow, myocardial oxygen consumption, and intermittent occlusion with reperfusion. Prompt reperfusion…

…pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing…

…pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing…

…Asymptomatic and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic…

…with ACS. Clinical manifestations therefore commonly include recurrent myocardial ischaemia, recurrent infarction, or acute coronary occlusion. Stent thrombosis may occur within hours or days of…

…CABG), or percutaneous coronary intervention (PCI), including attempted recanalization of a chronic total coronary occlusion. Angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA)…

…unexplained drop in arterial pressure. Silent or unrecognized infarction occurs more often in patients without antecedent angina and in those with diabetes and hypertension. Of

… However, T wave inversions that are accompanied by ST segment deviation (either depression or elevation) is representative of ischemia (but in that scenario, it is…

…causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of the artery; blood flow may be partially or completely obstructed. Consequently…

…within an hour of arterial occlusion. The classic clinical constellation is remembered as the “six Ps”: Pain Paresthesia Pallor Pulselessness Poikilothermia, or coldness Paralysis Pain…

…instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…involve partial occlusions, resulting in subendocardial ischemia and comparatively milder symptoms. For the same reason, patients with STEMI are at higher risk of life threatening…

…substantially exceeding those seen with native vessel PCI. Mechanisms The principal mechanism is distal embolization of atheromatous and thrombotic material. Plaque or thrombus may be…

…Coronary dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft Side branch occlusion or thrombus Disruption of collateral…

…identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window, or when thrombectomy…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…linking). Concurrent activation of the coagulation cascade leads to thrombin generation and fibrin deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS…