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An Unusual Acute Coronary Syndrome

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Course Details

Credit/contact hours: .5
Estimated time to complete: 30 minutes
Publication Date: July 11, 2018
Expiration date: July 10, 2024
Reviewed: July 9, 2021


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.

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.

Lawrence W Gimple, MD

Dr. Gimple is an attending cardiologist at the University of Virginia Health System with a sub-specialty in interventional cardiology.  He serves as the Director of Clinical Cardiology at the University of Virginia Health System with clinical interests in coronary artery disease, coronary stenting, and heart attack.

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

Elona Rrapo Kaso, MD

Dr. Elona Rrapo Kaso is a Fellow in Cardiovascular Disease at the University of Virginia Health System.

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

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