Modern care for acute ST-Elevation Myocardial Infarction (STEMI) involves rapid mobilization of cardiology resources including patient evaluation and transfer to a capable cardiac catheterization laboratory for coronary angiography and, when appropriate, for coronary intervention with stenting of the occluded infarct artery. However, not all patients presenting with chest pain and ST-Elevation on the ECG will have an acutely occluded coronary artery related to plaque rupture and thrombosis of atherosclerotic plaque. ST-elevation can result from other diagnoses such as pericarditis or early normal repolarization. ST-elevation can be a chronic finding in patients with prior MI. In addition, coronary arteries can become acutely occluded by other mechanisms such as embolism of vegetation (endocarditis), severe coronary spasm, or spontaneous coronary artery dissection (SCAD). In this case, we present a patient with STEMI and there is a diagnostic and therapeutic challenge.

Course Details

In this course, you will learn:
  • To specify the differential diagnosis of patients presenting with chest pain and no typical atherosclerotic occlusion.
  • To define the proper diagnostic and therapeutic approaches to patients presenting with suspected spontaneous coronary artery dissection (SCAD).
  • To outline a rational evaluation of other arterial sites in patients with SCAD who may additional have fibro-muscular dysplasia in other arterial beds.

Method and medium:

Learners participate in the interactive learning modules by correctly answering multiple choice questions dispersed throughout. Learners will be prompted to try again if a question is answered incorrectly.

The course will open in a new tab – to exit the course, simply close that tab.


Estimated time to Complete: 30 minutes
Credit/contact hours: .5
Expiration date: July 10, 2021
Publication date: July 11, 2018

User Rating: 4.9/5 (3) Rating Details

Course Authors

Lawrence W Gimple, MD

Dr. Gimple isĀ an attending cardiologist at the University of Virginia Health System with a sub-specialty in interventional cardiology.
Learn More about Lawrence W Gimple, MD.

DISCLOSURE: This individual reports no relevant financial relationships with commercial entities.

Elona Rrapo Kaso, MD

Cardiology Fellow

Learn More about Elona Rrapo Kaso, MD.

DISCLOSURE: This individual reports no relevant financial relationships with commercial entities.