…proportion of painless or silent STEMIs is greater in patients with diabetes mellitus and increases with age. STEMI may present as sudden onset breathlessness. Other…

…cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism, dissection, coronary arteritis associated with systemic vasculitis, extrinsic compression, myocardial bridging and radiation…

…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…

…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…

…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…

…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…

…between myocardial oxygen supply and demand. In many cases, the initiating process is plaque disruption with thrombosis; other cases result from spasm, microvascular dysfunction, embolism…

…endothelial function and favour the accumulation of fat, smooth muscle cells, fibroblasts and extracellular matrix beneath the endothelium. Plaques that are particularly prone to rupture…

…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)…

…ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period…

…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…

…particularly important in determining management. The benefit of carotid revascularisation is greatest in patients with a recent TIA or stroke, particularly when the event occurred…

…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…

…and lesion haziness raise suspicion of thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features that may…

…a modest, dose dependent reduction in triglycerides. The benefit of statins extends beyond angiographic reduction of coronary obstruction. Intensive lipid lowering improves endothelial function, lowers…

…with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial proportion present…

…reduce embolization of thrombotic or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for…

…Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather…

…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…

…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…

…inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during infections). As noted by Bonow et al…

…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…

…5 Physiological Mechanisms of Cardioprotection: Direct vs. Weight Mediated The profound cardiovascular benefits observed with incretin based therapies cannot be explained by glucose lowering alone…

…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

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

…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…

…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…

…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…