…showing the same branches as in panel A for cross modality comparison. Clinical features Occlusion of the left main coronary artery (LMCA) abruptly interrupts blood…

…The left main coronary artery ( LMCA ) originates from the left anterior aspect of the aortic bulb. The LMCA is short and branches into the two…

…and form of the thrombus, it will occlude the main pulmonary artery or its branches. The larger the thrombus, the more proximal the occlusion and…

…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…

…lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac output. Their recognition is essential because treatment…

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

…left ventricular wall in over 90% of all individuals. Hence, a proximal occlusion (in the RCA) which cuts off blood flow to the right ventricle…

…The severity of ischaemia and whether infarction has occurred The extent and degree of myocardial involvement The anatomical territory, including anterior, inferoposterolateral or right ventricular…

…waves ( Figure 2 shows right ventricular hypertrophy). The following rules will distinguish the two conditions in the vast majority of cases: Right ventricular hypertrophy shifts…

…not be depolarized via the Purkinje network, but rather via spread of the depolarization from the right ventricle. The abnormal ventricular depolarization will cause an…

…substantial number of these patients had complete coronary artery occlusions, and outcomes improved when they were treated as acute STEMI cases. Management of left bundle…

…ischemia and infarction Definition and conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia…

…identification of acute coronary occlusion (Al Zaiti et al, 2023). The proposed transition from the traditional STEMI/NSTEMI/UA classification to the OMI/NOMI approach…

…without significant ST segment elevations on ECG. NSTE ACS is caused by partial occlusion of the artery (i.e. coronary blood flow is not completely…

…acute total occlusion of an epicardial coronary artery (i.e. STEMI), pathological Q waves can develop already within 2 hours after the onset of infarction…

…infarction The ECG in the assessment of myocardial reperfusion The ECG is an invaluable tool to assess whether an occlusion has been resolved and blood…

…ESC), American College of Cardiology (ACC), American Heart Association (AHA), and World Heart Federation (WHF) collaborated to redefine MI using a biochemical and clinical approach…

…after coronary occlusion and progress over time. Experimentally, necrosis advances from the subendocardium towards the subepicardium over several hours. The extent and tempo of injury…

…with oxygen demands. Depending on several factors– including the severity of the stenosis/occlusion, microvascular function, myocardial oxygen extraction, presence of collateral circulation, etc –ischemia…

…and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial…

…and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial…

…PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying the limbs. In adults over 40 years of age…

…diagnostic angiography. Collateral vessels may maintain distal perfusion and permit visualization of the vessel beyond the occlusion when the patent donor artery is injected. The…

…recurrent infarction, or acute coronary occlusion. Stent thrombosis may occur within hours or days of implantation or many months to years later. Recurrent chest pain…

…with CAD. The pathophysiology of refractory angina is heterogeneous. In obstructive CAD, symptoms may result from extensive or diffuse epicardial disease, chronic total occlusion, incomplete…

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

…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…

…Disruption of an atherosclerotic plaque may also release atherosclerotic debris downstream, causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of…

…Clinical presentation and symptoms Symptoms commonly develop rapidly, often within an hour of arterial occlusion. The classic clinical constellation is remembered as the “six Ps…

…opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI criteria and occlusion…

…whether coronary stents are present. Clinical objectives of therapy The main objectives of antiplatelet treatment after MI are to: prevent recurrent MI; reduce ischaemic stroke…

…myocardial ischaemia caused by transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia…

…the ischemia/infarction. The location of the thrombus in the artery: a proximally located thrombus will cut off blood flow to more branches, and thus…

…is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to…

…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…

…The clinical importance of the finding is related to the extent of myocardium at risk. Occlusion or impaired perfusion in a vessel supplying a large…

…or chest pain equivalent symptoms. The ECG assessment remains necessary even when symptoms have improved by the time of medical evaluation, because transient or evolving…

…no coronary artery occlusion can be identified. Injection of contrast media into the ventricle will instead reveal that the apical portion of the left ventricle…

…Stent thrombosis Graft occlusion after CABG No reflow despite removal of an apparent epicardial stenosis The clinical consequences depend on the amount of viable myocardium…

…The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset…

…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…

…total occlusion is an important predictor of incomplete anatomical revascularization with PCI. PCI of chronic total occlusion lesions may improve angina and quality of life…

…encompasses several physiological states. Brief coronary occlusion or relatively prolonged moderate ischemia may produce post ischemic stunning. In the absence of infarction, contractile recovery can…

…coronary artery occlusions. This is discussed in detail in the chapter NSTEMI (Non ST Elevation Myocardial Infarction). Orientation of myocardial fibers The orientation of myocardial…

…left main coronary artery disease . It integrates multiple variables, including the number of lesions, their location, and specific characteristics such as bifurcations, chronic total occlusions…

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

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…or at least four drinks for women or five for men on one occasion. Pharmacokinetics and pathophysiology Approximately 95% of ingested ethanol undergoes hepatic metabolism…