…mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to…

…anatomical examination that depicts the coronary arterial lumen, atherosclerotic plaque, and the severity and distribution of coronary stenosis. Modern cardiac CT can acquire a three…

…and radiation. Quality and intensity. Precipitating factors, including exertion, emotional stress, meals, or exposure to cold. Relieving factors, including rest or medication. Time of day…

…myocardial bridging and radiation induced coronary disease. The distinction between UA and NSTEMI has become increasingly dependent on the use of highly sensitive cardiac troponin…

…single breath hold No intravenous line No premedication No special preparation Radiation exposure of approximately 1–1.5 mSv with contemporary techniques The total CAC…

…plaque morphology and location, comorbidities, environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial…

…NSTEMI), and ST segment elevation myocardial infarction (STEMI). The traditional term “vulnerable plaque” describes an atherosclerotic lesion thought to be susceptible to disruption and thrombosis…

…episodic plaque disruption followed by thrombosis. Atherosclerotic disease usually evolves over decades. Intimal thickening may be present during the second and third decades of life…

…endothelial coverage. Complementary Characteristics IVUS and OCT are complementary rather than interchangeable. IVUS generally provides better visualization of overall vessel dimensions, plaque burden, large vess

…also reduce production of apoB 100 containing lipoproteins and exert effects beyond LDL C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability…

…include fixed coronary atherosclerosis without plaque rupture, coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation)…

…the plaque exposes highly thrombogenic materials which activate circulating platelets and coagulation factors, which results in thrombus formation (Figure 1). Disruption of an atherosclerotic plaque…

…subclavian artery. Penetrating atherosclerotic ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media. The lesion…

…deposition and retention of LDL C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory reactions that promote plaque formation and progression…

…the preceding 6 months. Those with symptoms suggestive of TIA or stroke require neurological consultation and, when appropriate, neurovascular and brain imaging. Evaluation and Physical…

…can refine interpretation. Coronary plaque and future events Angiographic stenosis severity is an imperfect predictor of future myocardial infarction or sudden death. Lesions causing only…

…rehabilitation, ablative or surgical interventions The test does not define the structure or composition of coronary atherosclerotic plaque, identify plaques at high risk of rupture…

…coherence tomography (OCT) provide cross sectional information about plaque morphology and may clarify the mechanism of an acute coronary syndrome or guide percutaneous coronary intervention…

…related components of atherosclerotic plaque. These effects help explain why reductions in cardiovascular events are substantially greater than the usually modest anatomical regression of coronary…

…A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial proportion present with NSTEMI, although STEMI occurs…

…is distal embolization of atheromatous and thrombotic material. Plaque or thrombus may be dislodged by: Balloon inflation Atherectomy Stent implantation Manipulation of friable SVG lesions…

…sized arteries. Pathological features include plaque formation with calcium deposition, medial thinning, destruction of muscular and elastic tissue, fragmentation of the internal elastic lamina, and…

…and Myocardial Injury STEMI generally results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or…

…platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation…

…ACS . Virtually all cases of STE ACS lead to myocardial infarction (elevated troponin levels), whereafter the condition is classified as ST Elevation Myocardial Infarction (STEMI) …

…ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), and ST Elevation Myocardial Infarction (STEMI)…

…but an atherosclerotic plaque may prevent oxygen supply from increasing in parallel with oxygen demands. Depending on several factors– including the severity of the stenosis…

…results in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during…

…thickness, early plaque formation and coronary microvascular dysfunction. Women with RA were reported to have approximately twice the myocardial infarction risk of age matched controls…

…into the plaque through the disrupted surface. Type 2 MI: Attributed to an imbalance between myocardial oxygen supply and demand, without the presence of acute…

…shift. For decades, the management of type 2 diabetes mellitus (T2DM) and obesity was siloed, with clinicians focusing primarily on hemoglobin A1c (HbA1c) reduction, blood…

…Causes of myocardial injury Important causes include: Mechanism or clinical setting Examples Acute coronary atherothrombosis Plaque disruption or erosion with thrombosis Reduced myocardial perfusion Coronary…

…be accompanied by haemorrhage into the plaque. The diagnosis is supported by the general criteria for acute MI together with evidence of acute coronary atherothrombosis…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…Moreover, inflammation and risk factors also modify the risk of destabilization of the plaque. Atherosclerotic plaques are vulnerable and may disrupt, which may ultimately lead…

…and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine…

…thrombogenic and pro thrombolytic factors determines whether atherothrombosis occurs, and these factors vary from minute to minute. Only a minority of all plaque disruptions resul

…the site of future STEMI; rather, it is the biological composition and inflammatory activity of the plaque that dictate clinical risk [8] . Plaques The architecture…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…ischemic stroke (87% of all cases). The terms hemorrhagic stroke and intracerebral hemorrhage are used interchangeably. Hemorrhagic stroke implies bleeding directly into the brain parenchyma…

…possible or known plaques, or stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if there is suspicion of syncope due to an…