Myocardial injury: myocardial necrosis, seen as a rise in troponin, without evidence of acute myocardial ischaemia.Myocardial infarction: myocardial necrosis, seen as a rise in troponin, with evidence of acute myocardial ischaemia.There is a spectrum of acute and chronic myocardial damage that may occur with or without ischaemia. spontaneous, cocaine)Ĭhanges in oxygen demand and / or delivery: This leads to necrosis and troponin rise. Instead, there is not enough blood being delivered through the coronary arteries to meet the demand of the cardiomyocytes. In oxygen supply/demand mismatch, there is not total occlusion. emboli, dissection), whereas others are due to oxygen supply/demand mismatch (e.g. Some also result in vessel occlusion (e.g. There are a number of risk factors that increase the chance of developing atherosclerosis, they may be divided into modifiable and non-modifiable risk factors.Ĭauses other than atheromatous plaque rupture can lead to myocardial infarction and ACS. leads to myocardial necrosis, ECG changes and typical symptoms). If an atheromatous plaque ruptures, it leads to thrombus formation and acute occlusion that causes ACS (i.e. Narrowing secondary to atherosclerosis is known is coronary artery disease (CAD) or ischaemic heart disease (IHD).ĬAD/IHD can lead to angina, which refers to typical chest pain from myocardial ischaemia when there is an increase in the oxygen supply/demand (e.g. Atherosclerosis leads to narrowing of the coronary vessels, which supply the heart. Angiography or autopsy evidence of thrombusĪCS is typically triggered by rupture of an atheromatous plaque in the coronary arterial wall.Ītherosclerosis is the predominant cause of ACS.Imaging evidence of infarction: loss of viable myocardium or new motion abnormality.New or presumed new ECG changes: ST-T wave changes or new LBBB.Symptoms of myocardial ischaemia (e.g.In addition, there should be at least one of the following: troponin) to show a rise and/or fall with at least one value above the upper limit for normal (ULN). For the diagnosis, it requires the detection of a cardiac biomarker (e.g. MI is defined as 'evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischaemia'. UA: Characteristic clinical features, non-specific signs of ischaemia or normal ECG, normal troponins.Ī myocardial infarction (MI), which is more colloquially known as a 'heart attack', refers to death of cardiac tissue (i.e.NSTEMI: Non-specific signs of ischaemia or normal ECG, raised troponins.STEMI: ST-segment elevation or new-onset left bundle branch block and raised troponins.ClassificationĪCS is classified into one of three conditions according to clinical features, ECG findings and cardiac enzymes: Atherosclerosis represents the most significant aetiological factor. Around 100,000 people are admitted with ACS in the UK each year. Acute coronary syndrome (ACS) refers to three states of myocardial ischaemia: unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).ĪCS is a medical emergency requiring urgent admission.
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