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This registry will aim to provide world-wide physicians the most accurate information on coronary plaque to improve cardiovascular risk prediction and support the selection of patient-specific treatment,” said Dr. De Cecco. The ultimate goal is to positively impact cardiovascular health globally with a reduction in cardiovascular events."
The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?
This suggests further severe ischemia. MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. And yet the arteries remain open.
tim.hodson Tue, 10/01/2024 - 10:50 PHOTO CAPTION: The Elucid PlaqueIQ user interface is a fully interactive visualization of the patient’s coronary anatomy, showing specific plaque type and amount across various views to inform physician assessment of risk and patient-specific treatment pathway.
A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. There are 3 types of coronary atherosclerosis visible on CTCA: Calcified Plaque - Easily Identified on both CT CAC & CTCA scans. Subscribe now How Often Does A CT CAC Scan Miss Plaque?
Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 7 Research has shown inflammation plays a significant role in the development of atherosclerosis and ASCVD,8-10 and even the formation of plaque.11 4 In the U.S. References: 1.
His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Am J Med 2019, 132(5):622-630.
To prove there is no plaque rupture, you need to do intravascular ultrasound (IVUS). An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!! One of the most common is rupture of a non-obstructive plaque, with thrombus formation and OMI that spontaneously lyses and leaves a wide open artery. It can only be seen by IVUS.
This strongly suggests reperfusing RCA ischemia. Troponins, echocardiogram An echocardiogram showed inferobasilar hypokinesis, further supporting a diagnosis of regional ischemia , likely of the area supplied by the RCA. Here’s the angiogram of the RCA : No thrombus or plaque rupture in the RCA (or any coronary artery) was found.
The septum appears a bit darker than the rest, and you might be fooled into thinking there is ongoing ischemia here. Dr. Punjabi has a fantastic radiology blog on Spectral CT: [link] A negative CT should not be relied upon to rule out ischemia. See an examples of CT ischemia here. Another troponin returned at 23.89
[link] Case continued: In this case, the diagnosis was much easier because there was a prehospital ECG: less than 1 mm ST Elevation in II, III, aVF, with minimal ST depression in aVL This is diagnostic of inferior OMI No clear evidence of ischemia Computer interpretation Impressive! This algorithm called it a STEMI.
RCA ischemia often results in sinus bradycardia from vagal reflex or ischemia of the sinus node. He was taken to the cath lab and underwent emergent intervention: Thrombotic stenosis of the proximal RCA (95% with evidence of plaque rupture) is the culprit for the patient's inferoposterior STEMI. He was successfully stented.
It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Mechanisms of plaque formation and rupture. Coronary plaque disruption. Journal of Geriatric Cardiology , 19 (6).
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