…presents a classification of acute coronary syndromes and myocardial infarctions. The reader should study this chart carefully. Figure 1. Flowchart showing the natural course of…

…circulating thrombotic and fibrinolytic factors. Plaque erosion Plaque erosion is increasingly recognized and is present in at least one third of acute coronary syndromes in…

…by Smith and colleagues in 2018. This approach seeks to anchor diagnostic and therapeutic decisions in the presence or absence of an acute coronary occlusion…

…is indicated in patients with symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…epicardial vasomotor abnormalities or structural and functional microvascular disease. Thus, the presence of non obstructive epicardial arteries does not exclude a coronary cause of symptoms…

…in the chapter ST elevations in ischemia and differential diagnoses. In cardiac arrest caused by acute total occlusion of an epicardial coronary artery (i.e…

…physical signs for LMCAD. Diagnostic Assessment Coronary angiography Invasive coronary angiography defines: The presence and severity of left main stenosis Ostial, shaft or distal bifurcation…

…whether ACS or chronic coronary syndrome (CCS). Whether and how PCI was performed. The need for non cardiac surgery. The presence of an indication for…

…dyspnoea, and the presence of risk factors or previously identified coronary calcification. Age and sex remain important determinants of the expected prevalence of obstructive CAD…

…Represents a periprocedural myocardial infarction associated with coronary artery bypass grafting (CABG). Clinical Presentation and Symptoms The diagnosis of an acute MI remains a comprehensive…

…establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for individuals without…

…elevation acute coronary syndrome (NSTE ACS). The clinical spectrum includes patients with a confirmed NSTEMI, patients with a working diagnosis of NSTE ACS and a…

…than percutaneous coronary intervention (PCI). A CTO may be discovered incidentally during diagnostic angiography. Collateral vessels may maintain distal perfusion and permit visualization of the…

…a strategy involving coronary angiography and subsequent revascularization may be undertaken early, delayed, or selectively after initial medical treatment. The presence of ST segment changes…

…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…

…electrocardiogram (ECG) and the presence of troponin elevation, ACS are classified into unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI), and ST segment…

…of coronary artery disease (CAD) and guide the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) . Developed through expert consensus and…

…family history, particularly in the broader assessment of peripheral arterial and aortic disease; planned surgery, especially carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), or…

…various stages before and after revascularization procedures (PCI or coronary artery bypass grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart…

…and coronary artery disease (CAD) are used interchangeably throughout this text. Wall motion abnormalities in ischemic heart disease In the setting of stable ischemic heart…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…may involve coronary or non coronary factors, and ischaemic thresholds vary substantially between individuals depending on the magnitude of the stressor, the presence of non…

…Atherosclerotic disease usually evolves over decades. Intimal thickening may be present during the second and third decades of life, while clinical manifestations commonly emerge much…

…adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast…

…instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These…

…function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to the renal veins and can reduce…

…Epicardial and microvascular angina can coexist, and this combination is associated with a worse prognosis. VA may occur in the presence of obstructive coronary artery…

…dosing Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome…

…in older people and in patients with diabetes. The haemodynamic consequences depend on lesion location, severity, length, the presence of multilevel disease and collateral circulation…

…demand and coronary blood supply. Stress increases myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of a flow limiting coronary…

…the coronary arteries. The tumors can be asymptomatic for a long time and be detected randomly when investigating other conditions. More dramatic onset of symptoms…

…factors for HFpEF include hypertension (present in 80% of cases), obesity, type 2 diabetes mellitus, chronic kidney disease (CKD), sedentary lifestyle, and atrial fibrillation (AF)…

…treated patients may develop premature CAD. Symptoms therefore depend on the vascular territory involved and may include manifestations of coronary, cerebral or peripheral arterial disease…

…with HFpEF and have a greater likelihood of coronary artery disease, which is present in approximately 50–60% of patients. Conversely, atrial fibrillation and non…

…Presence of potentially serious arrhythmias – due to the risk of circulatory collapse. Decompensated heart failure – due to the risk of circulatory collapse and arrhythmias Pulmonary…

…coronary spasm, thrombosis, fever, acute starvation, and dieting. Clinicians should maintain a high index of suspicion for drug induced arrhythmias in patients receiving agents known…

…of ST Elevation Several nonischemic conditions can produce ST segment elevations that mimic acute myocardial infarction. Acute pericarditis is a primary differential diagnosis and presents…

…consequences of diabetes may present through any major cardiovascular phenotype: CAD, including chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left…

…ratio of stress myocardial blood flow to resting myocardial blood flow. It provides an integrated measure influenced by epicardial stenosis, diffuse atherosclerosis, and coronary microvascular…

…and quality of life. The underlying aetiology is heterogeneous. Chronic heart failure evaluation should therefore seek reversible or treatable causes. The source material identifies coronary…

…5 days and resolution within about 1 week in the usual course. Severe AKI requiring dialysis is uncommon except in the presence of substantial pre…

…difficult in the presence of left bundle branch block. This is because left bundle branch block causes substantial changes in left ventricular depolarization and repolarization…

…coronary artery. LCX = left circumflex coronary artery. Arterial blood supply of the conduction system Figure 1 presents the components of the conduction system and…

…from physicians' and nurses' stations in order to not disturb the patients' rest. It was believed that the mere presence of physicians and nurses caused…

…in the presence of symptoms suggestive of ischaemia and presumed new ischaemic ECG changes. The distinction between myocardial injury and type 2 infarction is particularly…

…The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular disease. Age and sex category. Renal and…

…themselves establish the presence of thrombus. Evaluation and physical examination The physical examination is directed primarily toward the consequences of the infarction and LV dysfunction…

…rare but catastrophic manifestation of acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior descending (LAD) and left circumflex (LCx…

…present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and…

…present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

…crista terminalis , the entrance of the coronary sinus and the inferior vena cava, as well as cells around the mitral and tricuspid valves, which possess…

…disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures. Both can improve coronary flow…

…third of patients with MINOCA may present with STEMI. Pathophysiology and causes MINOCA encompasses several distinct mechanisms. These may be broadly divided into coronary causes…

…cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with…

…carotid, vertebral and coronary arteries. In one study cited in the source material, FMD was identified in 86% of patients with SCAD. SCAD should therefore…

…diagnosis of CAD Characteristics suggesting that good quality imaging is achievable It is particularly useful when the clinical question is whether CAD is present and…

…equivalent. Note that women, diabetics and older individuals with coronary artery disease may only present with dyspnea (which is then considered an angina equivalent). Notably…