Acute Coronary Syndromes

Spectrum of Acute Coronary Syndromes
Dx UA NSTEMI STEMI
Coronary thrombosis Subtotal occlusion Total occlusion
History Angina that is new-onset, crescendo or at rest; usually <30 min Angina at rest
ECG ± ST depression and/or TWI
ST elevations
Troponin/CK-MB ⊕ ⊕

Ddx (causes of myocardial ischemia/infarction other than atherosclerotic plaque rupture)

  • Nonatherosclerotic coronary artery disease (JACC 2018;72:2231)
    • Spasm: Prinzmetal’s variant, cocaine-induced (6% of chest pain + cocaine use r/i for MI)
    • Dissection: spontaneous (vasculitis, CTD, pregnancy), aortic dissection with retrograde extension (usually involving RCA → IMI) or mechanical CI, surgery, trauma)