…contrast CT acquisition ECG gating A single breath hold No intravenous line No premedication No special preparation Radiation exposure of approximately 1–1.5 mSv…

…the presentation represents ACS and whether the patient is clinically unstable. Particular attention is required for evidence of: Ongoing or recurrent chest discomfort. Haemodynamic instability…

…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…

…usually involves the central portion of the chest or the epigastrium and occasionally radiates to the arms. Less common sites of radiation include the abdomen…

…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…

…longer. The usual location is the central chest or epigastrium. Radiation may occur to one or both arms and less commonly to the abdomen, back…

…potentially high risk plaques may exist throughout the coronary tree, while inflammation and thrombotic susceptibility are often systemic rather than confined to a single lesion…

…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

…contextual cues and attribution of pre existing symptoms to the medication. No single diagnostic test can distinguish a pharmacological SAMS effect from a nocebo response…

…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…

…disease depends substantially on stenosis severity and plaque characteristics. In the general population, the prevalence of asymptomatic carotid stenosis of at least 70% is low…

…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…

…Coronary mechanisms Coronary mechanisms include: Plaque rupture or plaque erosion with thrombosis, despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial…

…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…

…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…

…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…

…on the size of the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow…

…of the cap, leading to structural failure. Rupture exposes highly thrombogenic subendothelial matrix components, notably tissue factor and collagen, to the circulating blood [3] . Plaque…

…emergency medicine since the presence of wall motion abnormalities in a patient with chest pain strongly suggests myocardial ischemia as the underlying cause of the…

…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…

…increase the number and size of atherosclerotic plaques. Typically, the first manifestation of coronary artery disease is stable angina, defined by exercise related chest pain…

…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

…synthesis and degradation. Histologically, a vulnerable plaque is defined by a fibrous cap thickness of less than 65 μm, heavy macrophage infiltration, sparse smooth…

…increase the number and size of atherosclerotic plaques. Typically, the first manifestation of coronary artery disease is stable angina, defined by exercise related chest pain…

…may reveal atherosclerotic plaques, thrombi, occlusions, and dissections. Stroke is subdivided into hemorrhagic stroke (13% of all cases) and ischemic stroke (87% of all cases…

…response of both hypotension and bradycardia. However, some patients exhibit a primary cardioinhibitory response with pronounced bradycardia. Most cardioinhibitory events are due to sinus bradycardia…