Info

🌱 來自: acute coronary syndromes

Ddx causes of myocardial ischemia infarction other than atherosclerotic plaque rupture

• table of Ddx causes of myocardial ischemia infarction other than atherosclerotic plaque rupture 󰒖

Ischemia w/o plaque rupture (“type 2” MI)

• ↑ demand (eg, ↑ HR),
• ↓ supply (eg, HoTN).
• More likely in older, ♀,
• non-CAD comorbidities (CKD, etc.) (JACC 2021;77:848).
• Distinguishing from ACS is 󰶻clinical dx; angiography is 󰶻 gold standard.

Nonatherosclerotic coronary artery disease (JACC 2018;72:2231)

• Spasm:
  • Prinzmetal s variant angina
  • cocaine-induced (6% of chest pain + cocaine use r/i for MI)
• Dissection: spontaneous (vasculitis, CTD, pregnancy), aortic dissection with retrograde extension (usually involving RCA → IMI) or mechanical (PCI, surgery, trauma)
• Embolism (Circ 2015;132:241): AF, thrombus/myxoma, endocard., prosth valve thrombosis
• Vasculitis:
  • Kawasaki syndrome
  • Takayasu arteritis
  • Polyarteritis nodosa, PAN
  • Churg-Strauss syndrome
  • SLE
  • RA
• Congenital: anomalous origin from aorta or PA, myocardial bridge (intramural segment)

Direct myocardial injury

myocarditis; Takotsubo/stress CMP; toxic CMP; cardiac contusion