the vulnerable plaque
DESCRIPTION
The Vulnerable Plaque. Thin, Vulnerable, Fibrous Cap. Large Lipid Core. Reproduced with permission from Falk E, et al. Circulation. 1998;92:657-671. Ruptured Plaque with Occlusive Thrombus Formation. Thrombus Formation. - PowerPoint PPT PresentationTRANSCRIPT
The Vulnerable Plaque
Reproduced with permission from Falk E, et al. Circulation. 1998;92:657-671.
Large Lipid Core
Thin, Vulnerable, Fibrous Cap
Ruptured Plaque with Occlusive Thrombus Formation
Reproduced with permission from Falk E, et al. Circulation. 1998;92:657-671.
ThrombusFormation
Atherothrombosis: Thrombus Superimposed on Atherosclerotic Plaque
Adapted with permission from Falk E, et al. Circulation. 1998;92:657-671. Slide reproduced with permission from Cannon CP. Atherothrombosis slide compendium. Available at: www.theheart.org.
Characteristics of Unstable and Stable Plaque
Thin fibrous cap
Inflammatory cells
FewSMCs
Erodedendothelium
Activatedmacrophages
Thickfibrous cap
Lack ofinflammatory cells
Foam cells
Intactendothelium
MoreSMCs
Adapted with permission from Libby P. Circulation. 1995;91:2844-2850. Slide reproduced with permission from Cannon CP. Atherothrombosis slide compendium. Available at: www.theheart.org.
Unstable Stable
Thrombus Formation and ACS
UA NQMI STE-MI
Plaque Disruption/Fissure/Erosion
Thrombus Formation
Non-ST-Segment Elevation Acute Coronary Syndrome (ACS)
ST-Segment Elevation Acute Coronary Syndrome (ACS)
Old Terminology:
NewTerminology:
Superficial Erosion
Modified from Libby PCirc 104:365,2001
Ruptured Fibrous Cap
Sudden Thrombus or Thromboembolism
PathophysiologyAngiographic evidence of coronary thrombus formation may be seen in:>90% of patients with STEMI 35-75% of patients with unstable angina or NSTEMI1% of patients with stable angina
No ST Elevation ST Elevation
Acute Coronary Syndrome
NQMI Qw MI
NSTEMI
Myocardial Infarction
Davies MJ Heart 83:361, 2000
Ischemic DiscomfortPresentation
Working Dx
ECG
Biochem. Marker
Hamm Lancet 358:1533,2001
Unstable AnginaFinal Dx
Clinical presentation
• Chronic stable angina or chronic stable angina(CCS)
• Acute coronary syndrome(ACS)
Abbreviations
•Precipitating Factor •Quality•Relief•Site •Time
VERY VERY IMPORTANT
• Effect of CAD RF like DM, HTN, HLP on history taking in Unstable angina
• History taking is very very important so …….