1,721,003 research outputs found
A focus on the prognosis and management of ischemic heart disease in patients without evidence of obstructive coronary artery disease
No full textAspirin 'resistance', diabetes mellitus and no-reflow: the elusive role of individual susceptibility in myocardial reperfusion
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Acute coronary syndrome without coronary obstructions: Diagnosis and treatment
No full text>Myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) is a syndrome with different causes. Its prevalence ranges between 5% and 25% of all myocardial infarctions. The prognosis is extremely variable, as it strictly depends on the cause of MINOCA. Clinical history, electrocardiography, cardiac enzymes, echocardiography, coronary angiography, and left ventricular angiography represent first-level diagnostic investigations to identify the causes of MINOCA. This preliminary step helps divide patients presenting with epicardial or microvascular patterns and to perform specific additional tests for an adequate management workflow. This article will focus on the diagnosis and treatment of MINOCA
[Acute myocardial infarction with angiographically normal coronary arteries: what are we missing?]
No full textMyocardial infarction with normal coronary arteries (MINCA) can be observed in a relevant subset of patients with MI. It can be considered a syndrome, since it includes several clinical entities with specific pathogenetic mechanisms. Its prevalence is extremely variable, accounting for 5-25% of all acute myocardial infarctions. MINCA may arise from epicardial, microvascular, or myocardial localizations. Clinical history, echocardiography, coronary angiography and left ventriculography represent the first diagnostic step; however, additional tests are often required to confirm the diagnosis. The prognosis is extremely variable, depending on the causes of MINCA. Therefore, the identification of the correct etiology of MINCA is crucial to stratify patients appropriately and, hence, select the best treatment approach. In this review article, the pathogenesis, diagnosis, prognosis and therapy of MINCA are discussed, highlighting that coronary angiography alone is not sufficient for the complete understanding of the pathogenic mechanism
Editor's Choice- Pathophysiology, diagnosis and management of MINOCA: an update
Full text linkMyocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome with different causes, characterised by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. Its prevalence ranges between 5% and 25% of all myocardial infarction. The prognosis is extremely variable, depending on the cause of MINOCA. The key principle in the management of this syndrome is to clarify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, cardiac enzymes, echocardiography, coronary angiography and left ventricular angiography represent the first level diagnostic investigations to identify the causes of MINOCA. Regional wall motion abnormalities at left ventricular angiography limited to a single epicardial coronary artery territory identify an 'epicardial pattern'whereas regional wall motion abnormalities extended beyond a single epicardial coronary artery territory identify a 'microvascular pattern'. The most common causes of MINOCA are represented by coronary plaque disease, coronary dissection, coronary artery spasm, coronary microvascular spasm, Takotsubo cardiomyopathy, myocarditis, coronary thromboembolism, other forms of type 2 myocardial infarction and MINOCA of uncertain aetiology. This review aims at summarising the diagnosis and management of MINOCA, according to the underlying physiopathology
Prevention of Coronary Microvascular Obstruction by Addressing the Individual Susceptibility
Full text linkAnother pathogenetic component of coronary microvascular obstruction (CMVO) is constituted by the individual susceptibility to microvascular dysfunction, probably related to the function, as well as to the structure and the density of the microcirculation. Common and uncommon cardiovascular risk factors can cause a pre-existing transient or permanent microvascular dysfunction, which contributes to the development and prognosis of acute coronary syndrome. Moreover, genetic factors may enhance the individual susceptibility of CMVO, affecting polymorphism of genes responsible of the onset, trigger and/or modulation of coronary microvascular dysfunction, as well as the resistance to the lysis. Finally, ischemic pre-conditioning may determine the individual susceptibility to CMVO, by protecting both the myocardium and the coronary microcirculation. This chapter summarizes the mechanisms, the effects, the prevention, and treatment of the single causes of individual susceptibility to CMVO
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