Related Experiment Videos
[Etiology, pathogenesis and clinical course of unstable coronary artery disease]
1Semmelweis Egyetem, Altalános Orvostudományi Kar II. sz. Kardiológiai Tanszék, Budapest.
Insights
Unstable coronary artery disease (UCAD), encompassing unstable angina and non-Q-wave myocardial infarction, stems from atherosclerotic plaque rupture. This review details UCAD
Area of Science:
- Cardiology
- Pathophysiology
- Vascular Biology
Context:
- Ischemic heart disease presents with acute ischemic syndromes, including unstable angina and myocardial infarction.
- Unstable angina and non-Q-wave myocardial infarction share common pathophysiology rooted in atherosclerotic plaque rupture and thrombosis.
- These conditions represent a spectrum of acute coronary syndromes distinct from ST-elevation myocardial infarction.
Purpose:
- To consolidate unstable angina and non-Q-wave myocardial infarction under the umbrella term 'unstable coronary artery disease' (UCAD).
- To review the etiology, pathophysiology, and role of inflammation in UCAD.
- To discuss diagnostic challenges and risk stratification strategies for UCAD based on current European Society of Cardiology guidelines and evidence-based studies.
Summary:
- Plaque rupture or erosion initiates UCAD, releasing thrombogenic material that forms non-obstructive, platelet-rich thrombi.
- Adequate collateral circulation prevents transmural necrosis, differentiating UCAD from ST-elevation myocardial infarction.
- UCAD shares uniform etiologic, risk stratification, and therapeutic backgrounds, necessitating distinct management approaches.
Impact:
- Provides a unified framework for understanding and managing unstable angina and non-Q-wave myocardial infarction.
- Highlights the critical role of inflammation in the pathogenesis of UCAD.
- Offers insights into current diagnostic and therapeutic strategies, aligning with recent European guidelines.
Abstract:
The clinical presentations of ischemic heart disease comprises the term of acute ischaemia syndromes, that include unstable angina pectoris, non-Q-wave myocardial infarction, Q-wave-myocardial infarction and sudden death. Among the different presentations of acute ischemic syndromes, tha unstable angina and non-Q-wave myocardial infarction can be regarded together. In both pathologic entity, the plaque rupture, or erosion signifies the primary event, which is the source of the highly thrombogenic substances coming out from the core of the atherosclerotic plaque and entering to the coronary and systemic circulation. They cause a thrombocyte-rich "white" intracoronary thrombus, that is not fully obstructive, or there is adequate collateral circulation, being the pathogenetic substrate that prevents the development of transmural necrosis. The nosologically-bound two clinical entity can be called as "unstable coronary artery disease" (UCAD), since they have uniform etiologic, risk stratification and therapeutic backgrounds and also therapeutic targets that are basically distinct, they are admitted for transmural "ST-elevation" infarction. The review is discussing the etiology, pathophysiology, the role of inflammation factors, the problems of diagnostics, as well as risk stratification of the disease in the light of the recent guidelines of the European Society of Cardiology and multicenter evidence based studies.