Pathophysiology of coronary syndromes

2016 ◽  
Author(s):  
Robert M. Bell
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Vessel Wall ◽  
Inflammatory Process ◽  
Unstable Plaque ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

The pathophysiology of acute coronary syndromes is characterized by an acute mismatch of blood supply to the myocardium to meet the prevailing metabolic need. By far the commonest aetiology of myocardial ischaemia is coronary artery disease . An inflammatory process that evolves over the period of many decades, coronary artery disease is characterized by the deposition of cholesterol and cholesterol laden macrophages within the intima of the vessel wall. This process can be accelerated by a number of cardiovascular risk factors (smoking, hypertension, hyperlipidaemia, hypercholesterolaemia, diabetes), which can culminate in the formation of the unstable plaque responsible for the emergent presentation of ST-elevation myocardial infarction. This chapter reviews the prolonged inflammatory process responsible for atheroma formation, along with rarer, non-atheroma-related causes of acute coronary syndromes.

C-Reactive protein and coronary artery disease: Additional evidence of the implication of an inflammatory process in acute coronary syndromes

1999 ◽  
Vol 137 (2) ◽  
pp. 346-351 ◽  
Author(s):  
Idrissia Abdelmouttaleb ◽  
Nicolas Danchin ◽  
Claudio Ilardo ◽  
Isabelle Aimone-Gastin ◽  
Michael Angioï ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Inflammatory Process ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Coronary Syndromes ◽  
Artery Disease

Epidemiology and pathophysiology of coronary artery disease

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

This chapter presents the epidemiology and pathophysiology of stable ischaemic heart disease and acute coronary syndromes, i.e. unstable angina/non-ST elevation myocardial infarction and ST elevation myocardial infarction.

scholarly journals Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Olivia Manfrini ◽  
Jinsung Yoon ◽  
Mihaela van der Schaar ◽  
Sasko Kedev ◽  
Marija Vavlukis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Sex Differences ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Link Type ◽  
Coronary Syndromes ◽  
Traditional Risk Factors ◽  
Artery Disease

Background It is still unknown whether traditional risk factors may have a sex‐specific impact on coronary artery disease (CAD) burden. Methods and Results We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries; Clini​calTr​ials.gov , NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between traditional risk factors and severity of CAD and its relationship with 30‐day mortality. Relative risk (RR) ratios and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Estimates were compared by test of interaction on the log scale. Severity of CAD was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD. The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49 (95% CI, 0.41–0.60) and among those with diabetes mellitus was 0.89 (95% CI, 0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95% CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P =0.018. There were no significant sex‐related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30‐day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with nonobstructive CAD. Conclusions Obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT01218776.

scholarly journals Missed myocardial infarction in a vicenarian with malignant anomalous right coronary artery causing acute coronary syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nafeesah Ali ◽  
Kandace Baggan ◽  
Shari S. Khan ◽  
Paramanand Maharaj ◽  
Ronan G. Ali
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Low Risk ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease

Abstract Background Traditional coronary artery disease risk factors are well established and help risk stratify most patients presenting with chest pain syndromes. Young patients (under age 30 years) without other risk factors are thought to be at very low risk of coronary artery disease and acute coronary syndromes. Case presentation We highlight the case of a 27-year-old Afro-Caribbean male who presented to hospital with chest pain and was discharged from the emergency room because he was thought to be low risk for ischemic heart disease. Laboratory investigations subsequently confirmed acute coronary syndrome. He was found to have an anomalous right coronary artery with a malignant origin running between the aorta and pulmonary artery eventually requiring surgical correction. Anomalous origins of the coronary arteries are rare causes of acute coronary syndromes, chest pain, and sudden cardiac death. Conclusion Our patient could have easily had an adverse outcome as his diagnosis was missed by the initial treating physician. It is important to consider anomalous coronary artery origin in the evaluation of young symptomatic patients who may be otherwise low risk and not have traditional risk factors for ischemic heart disease.

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