Usually the result of a thrombus from a ruputured atherosclerotic plaque blocking a coronary artery, this is usually made up of platelets so antiplatelet drugs are the mainstay of treatment (aspirin, clopidogrel)

Can also be due to gradual narrowing of the vessel

Secondary MI - MI not caused by a blockage, anaemia causing lack of O2 delivery to cardiac muscle

Types of ACS

• Unstable Angina (>20mins at rest) - ACS defined by absence of biochemical myocardial damage
• NSTEMI - acute ischaemic event causing cardiomyocyte necrosis
• STEMI - myocardial cell death, occurs due to prolonged mismatch between perfusion and demand

Epidemiology

Cardiovascular disease is the greatest cause of death globally for men and women, greatest in >65 yr olds, women present more often.

• NSTEMI - more common (70% of ACS presentations), women present more often
• STEMI - 175,000 annually in uk. 15% of patients die in 1st hour of symptom onset

Aetiology

ACS develops in patients with coronary artery disease (IHD), gradual build up of fatty plaques leads to 2 problems:

1. gradual narrowing - less blood and O2 to mayocardium = angina (demands not met)
2. sudden plaque rupture - plaque may rupture = sudden occlusion of the artery. No blood/O2 reaching that area of the myocardium

PC:

Central, constricting chest pain associated with: