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Related Concept Videos

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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Acute Coronary Syndrome I: Introduction01:30

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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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Coronary Artery Disease II: Pathophysiology01:26

Coronary Artery Disease II: Pathophysiology

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Coronary Artery Disease (CAD) originates from a series of events that impair the function of coronary arteries, the blood vessels responsible for delivering oxygen-rich blood to the heart muscle. The pathophysiology of CAD is closely linked to atherosclerosis, a chronic inflammatory and lipid-driven condition affecting the vascular endothelium.1. Endothelial DamageThe process begins with damage to the vascular endothelium, which serves as a protective barrier between the blood and the vessel...
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Coronary Artery Disease III: Clinical Manifestations01:30

Coronary Artery Disease III: Clinical Manifestations

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Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
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Coronary Artery Disease I: Introduction01:30

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Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
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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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Related Experiment Video

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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Spontaneous Coronary Artery Dissection: The Phantom Menace.

Nikolaos Spinthakis1, Nada Abdulkareem2, Mohamed Farag1

  • 1Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medicine, The University of Hertfordshire, UK.

Cardiology Research
|February 16, 2017
PubMed
Summary

Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain that can be missed. Medical management with dual antiplatelet therapy is often preferred over intervention for SCAD patients, showing good response.

Keywords:
Conservative measureCoronary arteryDissectionPhantom menace

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Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Chest pain is a common presentation in emergency departments, often associated with acute coronary syndromes.
  • Traditional risk factors and diagnostic markers for myocardial infarction may not be present in all cases of chest pain.

Observation:

  • A 66-year-old female presented with chest pain, lacking dynamic electrocardiographic (ECG) changes and showing normal serial troponin levels.
  • Coronary angiography identified a linear filling defect in the first obtuse marginal branch of the circumflex artery, indicative of coronary artery dissection with superimposed thrombus.

Findings:

  • The case highlights Spontaneous Coronary Artery Dissection (SCAD) as a potential cause of cardiac chest pain that can be overlooked.
  • Medical management, including dual antiplatelet therapy, proved effective for this SCAD patient, leading to a favorable outcome.
  • SCAD management differs from other acute coronary syndromes; conservative treatment is generally superior to invasive intervention unless hemodynamic compromise occurs.

Implications:

  • Coronary angiography is crucial for diagnosing SCAD, especially in patients with unexplained chest pain and non-diagnostic initial evaluations.
  • Conservative medical management should be considered the primary treatment strategy for SCAD in the absence of hemodynamic instability.
  • This case underscores the importance of considering rare etiologies like SCAD in the differential diagnosis of acute chest pain.