The vascular endothelium is a dynamic endocrine organ that regulates contractile, secretory, and mitogenic activities in the vessel wall and hemostatic processes within the vascular lumen. Risk factors for atherosclerosis such as cigarette smoking, hypertension, and increased serum lipid concentrations impair endothelial function and lead to the development of atherosclerotic vessels, which cau...

BACKGROUND AND OBJECTIVES: Acute coronary syndromes (ACS) are one of the most common causes of ICU admissions. New drugs have been developed for management of ACS. These drugs reduced morbidity and mortality; however their adverse effects or their incorrect use may cause excessive bleeding. The objective of this review is to present the principal peculiarities, doses, and indications of these d...

Over the past 35 years, the view has evolved that the acute coronary syndromes, ie, unstable angina pectoris, myocardial infarction, and sudden death, are caused by plaque rupture and formation of a platelet thrombus. There is at least a transient total or subtotal coronary occlusion in all cases of acute myocardial infarction. Q-wave infarcts are thought to differ from non–Q-wave infarcts by m...

Antithrombotic agents are an integral component of the medical regimens and interventional strategies currently recommended to reduce thrombotic complications in patients with acute coronary syndromes (ACS). Despite great advances with these therapies, associated high risks for thrombosis and hemorrhage remain as the result of complex interactions involving patient comorbidities, drug combinati...

The American Heart Association and the American College of Cardiology,1,2 the European Society of Cardiology3,4 and others5 have developed comprehensive guidelines for the in-hospital management of patients with ST-elevation myocardial infarction (STEMI)2 and for unstable angina (UA) and non–ST-elevation MI (NSTEMI).1 The International Liaison Committee on Resuscitation (ILCOR) Acute Coronary S...

The term acute coronary syndrome (ACS) describes the spectrum of disease from acute myocardial infarction (MI) to unstable angina, as described in the first article of this feature (p285).The primary cause of these diseases is essentially the same — thrombosis of a coronary artery leading to ischaemia and possibly infarction of the myocardium.The degree of ischaemia or infarct size is related t...

STUDY OBJECTIVE We seek to determine whether cardiac risk factor burden (defined as the number of conventional cardiac risk factors present) is useful for the diagnosis of acute coronary syndromes in the emergency department (ED) setting. METHODS This was a post hoc analysis of the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS) registry, which had 17,713 ED visits for suspec...

I love to read studies that compare disease presentation, management, and outcome from an international perspective. Perhaps this interest is the result of factors present in my own life, i.e. frequent contact with family and close friends who live outside the United States. For nearly 40 years, I have maintained close contact with colleagues and members of my spouse’s family in Denmark. Of cou...

Inflammation is becoming an intriguing focus of research as a possible pathogenetic component and therapeutic target in ischaemic heart disease. However, the potential links between inflammation and ischaemic heart disease are present at three levels at least. First, the inflammatory response has been known for many years to play a major role in ischaemia/reperfusion injury, and its reduction c...

Acute coronary syndromes (unstable angina and non-Q-wave myocardial infarction) are caused by the rupture of an atherosclerotic plaque, platelet activation, and fibrin deposition resulting in thrombosis. Aspirin and unfractionated heparin have traditionally been the treatments of choice for patients with acute coronary syndromes. Low-molecular-weight heparins offer potential advantages over unf...