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Related Concept Videos

Pulmonary Embolism I: Introduction01:29

Pulmonary Embolism I: Introduction

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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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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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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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Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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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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A fresh look at coronary microembolization.

Petra Kleinbongard1, Gerd Heusch2

  • 1Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany.

Nature Reviews. Cardiology
|November 17, 2021
PubMed
Summary
This summary is machine-generated.

Coronary microembolization, caused by plaque erosion, links culprit lesions to non-ST-segment elevation myocardial infarction. This review explores microembolization mechanisms and treatments for improved outcomes.

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Area of Science:

  • Cardiovascular Medicine
  • Pathophysiology
  • Interventional Cardiology

Background:

  • Mechanical stress on coronary plaques releases debris and soluble substances, obstructing microcirculation and causing endothelial dysfunction.
  • This leads to microinfarcts and myocardial contractile dysfunction, contributing to acute coronary syndromes.
  • Non-ST-segment elevation myocardial infarction (NSTEMI) incidence has increased, with plaque erosion becoming a recognized key mechanism.

Purpose of the Study:

  • To characterize the features and mechanisms of coronary microembolization.
  • To discuss clinical trials of drugs and devices for prevention and treatment of coronary microembolization.
  • To propose coronary microembolization as a link between plaque erosion and NSTEMI.

Main Methods:

  • Review of existing literature on coronary microembolization.
  • Analysis of mechanisms involving particulate debris and soluble substances.
  • Discussion of clinical trial data for preventative and therapeutic strategies.

Main Results:

  • Coronary microembolization involves physical obstruction and soluble substance-induced dysfunction, leading to myocardial damage.
  • Current protective devices show modest benefits, and treatments primarily rely on antiplatelet and vasodilator agents.
  • Plaque erosion is increasingly recognized as a cause of NSTEMI, linked by microembolization.

Conclusions:

  • Coronary microembolization is a critical factor in the pathophysiology of NSTEMI, particularly in cases of plaque erosion.
  • Further research and improved therapeutic strategies are needed to address the impact of microembolization.
  • Understanding these mechanisms can guide the development of more effective treatments for acute coronary syndromes.