Nonatherosclerotic Causes of Acute Coronary Syndrome: Recognition and Management

Abstract

Acute coronary syndromes (ACS) frequently result from the rupture or erosion of a vulnerable coronary plaque, with associated intracoronary thrombosis. ACS also may occur in patients with angiographically normal coronary arteries. Some of these patients, however, still have angiographically silent underlying coronary artery disease. In this setting, subtle atherosclerotic changes frequently associated with unstable morphologic features or residual intracoronary thrombus may be detected with intracoronary imaging techniques. Nevertheless, other patients develop ACS as a result of nonatherosclerotic coronary artery disease (NA-CAD). ACS in patients with NA-CAD may be the consequence of coronary spasm or transient coronary embolic phenomena. In these patients, after the initial ischemic insult, late coronary angiography usually reveals normal epicardial coronary vessels. Kounis syndrome is a type of ACS generated by allergic reactions. Takotsubo cardiomyopathy is characterized by normal coronary arteries with a distinct pattern of transient left ventricular wall motion abnormalities. ACS also may occur in young patients following illicit drug use. Finally, spontaneous coronary artery dissection and intramural hematoma represent other etiologies of NA-CAD. In this review, we discuss current evidence regarding diagnostic and treatment strategies in patients presenting with ACS as a result of NA-CAD.

Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease

“…The estimated incidence of vasospasm in ACS is 1.5%. 5 In the 2 MI populations, the future risk for MI was similar between genders, but coronary artery revascularization was performed more often in men. The higher revascularization rates in men could reflect a higher atherosclerotic burden and natural progression to overt CAD.…”

“…The prevalence of takotsubo in patients presenting with signs and symptoms of ACS varies from 1% to 8%, occurring more frequently in postmenopausal women. 5,10 Myocarditis, which may mimic MI, is an additional differential diagnosis in these patients. 2 Concerning stroke, we did not find any gender differences in risk between the STEMI and NSTEMI cohorts, whereas in the chest pain population, risks were lower in women.…”

Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States

“…1 The deleterious cardiovascular and prothrombotic effects of cocaine use have been well established and may underlie a wide range of clinical cardiovascular presentations. 2 Its acute and more chronic presentations encompass a myriad of pathologies that range from acute coronary syndromes, heart failure, cardiomyopathies, arrhythmias, aortic dissection, to others. [3][4][5] Of these, chest pain continues to be the most common acute presentation of cocaine use and intoxication, which often leads to hospitalization and a full cardiovascular evaluation.…”

A Case of Typical Chest Pain: Takotsubo Cardiomyopathy Following Rhabdomyolysis

“…The international Takotsubo registry mentions TCM to be benign and risk of major adverse cardiac and cerebrovascular outcome was 9.9% and death risk is 5.6% per patientyear [10,11]. The most commonly proposed treatment is use of beta blockers and angiotensin-converting enzyme inhibitors [12].…”