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The Vulnerable Plaque

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.

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The Vulnerable Plaque

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  1. The Vulnerable Plaque Thin, Vulnerable, Fibrous Cap Large Lipid Core Reproduced with permission from Falk E, et al. Circulation. 1998;92:657-671.

  2. Ruptured Plaque with Occlusive Thrombus Formation Thrombus Formation Reproduced with permission from Falk E, et al. Circulation. 1998;92:657-671.

  3. 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.

  4. Characteristics of Unstable and Stable Plaque Unstable Stable Lack ofinflammatory cells Inflammatory cells Thickfibrous cap Thin fibrous cap FewSMCs MoreSMCs Intactendothelium Erodedendothelium Activatedmacrophages Foam cells 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.

  5. Thrombus Formation and ACS Plaque Disruption/Fissure/Erosion Thrombus Formation Old Terminology: UA NQMI STE-MI New Terminology: Non-ST-Segment Elevation Acute Coronary Syndrome (ACS) ST-Segment Elevation Acute Coronary Syndrome (ACS)

  6. Sudden Thrombus or Thromboembolism Superficial Erosion Ruptured Fibrous Cap Modified from Libby PCirc 104:365,2001

  7. Pathophysiology • Angiographic evidence of coronary thrombus formation may be seen in: • >90% of patients with STEMI • 35-75% of patients with unstable • angina or NSTEMI • 1% of patients with stable angina

  8. Hamm Lancet 358:1533,2001 Ischemic Discomfort Presentation Acute Coronary Syndrome Working Dx Davies MJ Heart 83:361, 2000 No ST Elevation ST Elevation ECG NSTEMI Biochem. Marker Myocardial Infarction Unstable Angina NQMI Qw MI Final Dx

  9. Clinical presentation • Chronic stable angina or chronic stable angina(CCS) • Acute coronary syndrome(ACS)

  10. Abbreviations

  11. Precipitating Factor • Quality • Relief • Site • Time

  12. VERY VERY IMPORTANT • Effect of CAD RF like DM, HTN, HLP on history taking in Unstable angina • History taking is very very important so …….

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