Clinical meaning
Atherosclerotic plaque rupture exposes the subendothelium to blood, activating the coagulation cascade. Platelets adhere via von Willebrand factor, activating GP IIb/IIIa receptors. Thrombus formation occludes the coronary artery, leading to anaerobic metabolism, ATP depletion, and cellular acidosis. Without reperfusion, necrosis begins in the subendocardium and extends transmurally.
Diagnosis & workup
Diagnostics & workup: - Order serial troponin I/T every 3-6 hours (high-sensitivity preferred) - Order 12-lead ECG within 10 minutes of presentation - Order BNP/NT-proBNP for heart failure assessment - Order echocardiogram for wall motion abnormalities - Order CBC, BMP, coagulation studies, lipid panel - Order CXR to evaluate for pulmonary edema - Order coronary angiography for STEMI (emergent PCI) - Calculate TIMI or GRACE risk score
Risk factors: - Uncontrolled hypertension - Hyperlipidemia with LDL > 160 - Diabetes mellitus with HbA1c > 7% - Smoking (dose-dependent risk) - Family history of premature CAD (male < 55, female < 65) - Metabolic syndrome - Chronic kidney disease - Cocaine/methamphetamine use - Autoimmune vasculitis