Pre-existing CAD (Stable Angina)
Rupture/erosion of the fibrous cap → exposed collagen → platelet activation → thrombus
Typical Angina Pectoris with ACS red flags
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ACS RED FLEG
| O | sudden onset at rest |
|---|---|
| T | progressive (worse then piror) |
| Associated | HR, BP changes |
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Sudden Onset at rest/worse Typical Angina Pectoris +/- !SOB (Dyspnea), Perspiration/Diaphoresis, Shoulder Pain, N/V - Nausea/vomitting, !Syncope +/- !Shock
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| Stable | Unstable (acute ischemia/infarction) | Physiology | ECG Findings in Unstable Condition | |
|---|---|---|---|---|
| Sub-endocardial | ‣ | ‣, NSTEMI | Small thrombus → partial blockage → embolism → downstream blockage of minor arteries | ‣ + ‣ |
| Transmural | NA | STEMI | Large thrombus → full blockage of main arteries | ‣ + Reciprocal ‣ |
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| ‣ (Chronic, Vaso-spatic) | ‣ | NSTEMI | STEMI | |
|---|---|---|---|---|
| Pathophysiology | Stable fixed plaque | Unstable plaque (platelet aggregation) | Thrombus (partial occlusion) | |
| *Doesn’t matter small vs. big vessel | Thrombus (full occlusion) | |||
| *Doesn’t matter small vs. big vessel | ||||
| Cardiac Enzyme (‣) ‣MB | normal/+ | normal/+ | ++ | +++ |
| ECG | TWI/Normal | STD/TWI/Normal | STD/TWI | |
| ‣ | STE | |||
| ‣ | ||||
| ‣ | Normal | RWMA/normal | RWMA (hypokinesia)/Normal | Regional* Akinesia, Decreased LVEF, Mechanical complications |
| Functional Test | ‣ | ‣ | X | X |
| Anatomical Test | Non-invasive (‣) | Depends | Invasive | |
| (‣) | Invasive | |||
| (‣) | ||||
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