Diseases of the coronary arteries, chest pain, myocardial infarction

Acut coronary syndrome

ST elevation (STEMI)
non ST elevation myocardial infarction (NSTEMI)

STEMI

An occlusive thrombus forming in a coronary artery, which forms on the ground of a ruptured or eroded atherosclerotic plaque (unstable plaque)

Subsurface procoagulant substances (cholesterol, tissue factor, collagen, etc.) cause the adhesion and aggregation of platelets and the formation of thrombin in direct contact with blood.

• New STelevation in two or more contiguous leads,

NSTEMI

An unstable plaque (see above), but usually a non-occlusive thrombus is formed, or a small coronary branch is occluded.

It is often aggravated by spasm, which is caused by substances released from inflammatory cells and platelets, as well as by microembolization of the peripheral vessels from the plaque

Risk factors

• atherosclerosis
• diabetes mellitus (type 2)
• hypertension
• smoking
• If several risk factors occur together, the probability of the occurrence of the event increases significantly.

Instrumental examination methods in cardiology

• 12-lead ECG
• Echocardiography
• Exercise ECG
• Holter ECG (for monitoring of treatment efficacy)
• Event recorder ECG
• Heart muscle scintigraphy
• Coronary CT •
Coronarography
• Electrophysiological examination/ablation, modification

Clinical signs

• Chest pain
• Heart failure
• Cardiogenic shock

Electrocardiography

• ST segment abnormalities
• Acute left bundle branch block (LBBB)

Laboratory markers/biomarkers

• cTroponin
• CK
•Others (myoglobin, GOT, LDH, BNP, hs CRP

Echocardiography

• Negative predictive value to rule out myocardial infarction

Stable angina

• Known conditions lead to symptoms
• Complaints have existed for at least a month
• They do not change in frequency or severity

Unstable angina

• Symptoms started within 1 a month
• Its nature and severity vary
• Calm complaints

Provoking factors of agnina

• Physical load
• Psychotic stress
• Meal
• Cold air

Left bundle branch block (LBBB)

• QRS>120 msec
• Dominant S wave in V1
• Broad monophasic R wave in lateral leads (I, aVL, V5-6)
• Secondar ST abnormalities
• Absence of Q waves in lateral leads • T wave discordance