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Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Vascular Spasm01:16

Vascular Spasm

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The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

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Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Resistant spontaneous coronary artery spasm.

Kudret Keskin1, Alparslan Şahin2, Süleyman Sezai Yıldız1

  • 1Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|November 6, 2015
PubMed
Summary

Coronary artery spasm is a critical consideration for myocardial infarction with normal coronary arteries. In refractory cases, catheter retraction and observation may resolve the spasm when vasodilators fail.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Myocardial infarction (MI) with normal coronary arteries (MINC) necessitates considering non-atherosclerotic causes like coronary artery spasm.
  • Coronary artery spasm can precipitate acute coronary syndromes, including MI, even without obstructive coronary artery disease.

Observation:

  • A 33-year-old woman presented with anterior myocardial infarction.
  • Coronary angiography demonstrated a normal left anterior descending artery and a new, complete occlusion of the circumflex artery during the procedure.
  • Intracoronary nitroglycerin up to 800 mcg was ineffective in relieving the circumflex artery occlusion.

Findings:

  • The case highlights a severe, nitroglycerin-resistant coronary artery spasm causing myocardial infarction.
  • Standard vasodilator therapy proved insufficient to address the acute arterial occlusion.

Implications:

  • This case suggests that in refractory coronary artery spasm unresponsive to vasodilators, mechanical interventions like catheter retraction and a period of observation may be a viable strategy.
  • Clinicians should maintain a high index of suspicion for coronary artery spasm in MINC and consider alternative management approaches when initial treatments fail.