2.4 Beyond Obstructive Coronary Disease

Question 1

What is MINOCA?

Answer 1

Myocardial Infarction with Non-Obstructive Coronary Arteries

Question 2

Type 1 Myocardial Infarction

Answer 2

Plaque Disruption: Rupture or Erosion

Question 3

Type 2 Myocardial Infarction

Answer 3

Oxygen Supply-Demand Imbalance

Question 4

Type 3 Myocardial Infarction

Answer 4

Ischaemia; sudden death before blood biomarkers can be obtained

Question 5

Type 4a Myocardial Infarction

Answer 5

During PCI procedure

Question 6

Type 4b Myocardial infarction

Answer 6

Stent causes thrombotic occlusion (AKA Stent Thrombosis)

Question 7

Type 5 Myocardial Infarction

Answer 7

Associated with cardiac surgery

Question 8

MINOCA criteria

Answer 8

• Acute ECG presentation
• Non-obstructive coronary arteries
• No apparent cause for presentation

Question 9

Typical profile of MINOCA patient

Answer 9

Young women

Question 10

Mechanisms of MINOCA

Answer 10

• Spasm

Question 11

Three criteria of vasospastic angina

Answer 11

1. Nitrate-responsive angina
2. Transient Ischaemic ECG changes
3. Coronary spasm on angiography

Question 12

True or false: coronary angiorams show a majority of the coronary tree

Answer 12

• False
• They only show about 5%

Question 13

Explain how measuring blood velocity can be used to determine resistance

Answer 13

• Velocity is used to determine flow
• Flow is used to determine resistance (where pressure is known)

Question 14

List some causes of Type 2 MI

Answer 14

• Coronary artery spasm
• Non-obstructive atherosclerosis
• Coronary dissection
• Oxygen supply/demand alone