Angina Plaque STEMI 
Dr. Smith's ECG Blog
SEPTEMBER 18, 2024
Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. Thus, it has recently become generally accepted that most plaque ruptures resulting in myocardial infarction occur in plaques that narrow the lumen diameter by 40% of the arterial cross section may be involved by plaque.
Dr. Smith's ECG Blog
DECEMBER 19, 2023
The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.
Dr. Smith's ECG Blog
JANUARY 5, 2024
Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. On the basis of unresolved angina, cardiology decided to perform rescue PCI. Although it is statistically unlikely, multiple plaque ruptures are possible. Heitner et al.
Dr. Smith's ECG Blog
MAY 20, 2024
The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia.
Dr. Smith's ECG Blog
APRIL 22, 2024
Patient still not having chest pain however this is more concerning for OMI/STEMI. Patient is pain free and clearly has Wellens' syndrome: 1) pain free episode following an episode of angina, typical Pattern A (biphasic, terminal T-wave inversion with an initial upsloping ST Segment) findings, preserved R-waves. Aspirin given.
Dr. S. Venkatesan MD
DECEMBER 2, 2023
This has important clinical significance , as many successfully lysed STEMI patient might have minimal segments of dissection/deep plaque fissures. , may be misdiagnosed as post infarct angina. Kim N Engl J Med 2020; 383:2358-2370 Next query What is the difference between plaque fissure and coronary arterial dissection?
Dr. Smith's ECG Blog
OCTOBER 24, 2018
This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina. There was good flow.
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