CORONARY ARTERY DISEASE

Clinico-pathological correlation in coronary vessels

• Fixed narrowing and stable plaque > stable angina (pain with exertion)
• Plaque rupture with partial thrombosis > unstable angina/UAP (pain at rest)
• Plaque rupture with complete thrombosis > myocardial infarction (MI)

Other terms in coronary artery disease

• Intermediate coronary syndrome = unstable angina
• Unstable plaque = plaque rupture with partial thrombosis
• Transmural infarct (TMMI) = infarction through entire cardiacl wall
• Sub-endocardial infarct (SEMI) - infarction involving endocardial layer (least oxygenated area)
• ST elevation infarct (STEMI) - MI with ST elevation on ECG
• Non ST elevation infarct (NSTEMI) - MI without ST elevation on ECG
• Acute coronary syndrome = any of the following UAP, NSTEMI, STEMI
• Stress test - a provocation test that can provoke myocardial ischaemia by increasing cardiac activity which is then detected by symptoms, ECG changes or echocardiographic abnormalities in wall contraction
• CAVG / CABG - coronary artery vein / bypass graft. Procedure using native vessels from saphenous vein or internal mammary to bypass atherosclerotic occlusion
• PTCA / PCA / PCI - Percutaneous (trans)coronary angioplasty, Percutaneous intervention - intraluminal usually via femoral artery to recanalise coronary vessel

Note that troponin will eventually rise in a MI but not necessarily in UAP.
ECG may not reliably distinguish SAP, UAP, MI, TMMI, SEMI