Pathophysiology of coronary syndromes

Robert M. Bell

Oxford Textbook of Critical Care (2 ed.)

Edited by Andrew Webb, Derek Angus, Simon Finfer, Luciano Gattinoni, and Mervyn Singer

Publisher:: Oxford University Press

Print Publication Date:: Apr 2016

Print ISBN-13:: 9780199600830

Published online:: Apr 2016

DOI:: 10.1093/med/9780199600830.001.0001

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Front Matter
- Foreword
- Preface
- Abbreviations
- Contributors
Section 1 ICU organization and management
- Part 1.1 The intensive care unit
- Part 1.2 Communication
- Part 1.3 Training
- Part 1.4 Safety and quality
- Part 1.5 Governance
- Part 1.6 Research
  - Chapter 23 Evidence-based practice in critical care
  - Chapter 24 Research ethics in the ICU
- Part 1.7 Medico-legal and ethical issues
- Part 1.8 Critical illness risk prediction
Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
  - Chapter 32 Oxygen in critical illness
  - Chapter 33 Bronchodilators in critical illness
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
  - Chapter 40 Gastrointestinal motility drugs in critical illness
  - Chapter 41 Stress ulcer prophylaxis and treatment drugs in critical illness
- Part 2.4 Nervous system drugs
- Part 2.5 Hormonal drugs
  - Chapter 49 Hormone therapies in critical illness
  - Chapter 50 Insulin and oral anti-hyperglycaemic agents in critical illness
- Part 2.6 Haematological drugs
  - Chapter 51 Anticoagulants and antithrombotics in critical illness
  - Chapter 52 Haemostatic agents in critical illness
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
Section 3 Resuscitation
- Part 3.1 Respiratory management
  - Chapter 59 Airway management in cardiopulmonary resuscitation
  - Chapter 60 Artificial ventilation in cardiopulmonary resuscitation
- Part 3.2 Circulatory management
- Part 3.3 Fluid management
Section 4 The respiratory system
- Part 4.1 Physiology
  - Chapter 71 Normal physiology of the respiratory system
- Part 4.2 Respiratory monitoring
- Part 4.3 Upper airway obstruction
  - Chapter 79 Upper airway obstruction in the critically ill
- Part 4.4 Airway access
- Part 4.5 Acute respiratory failure
- Part 4.6 Ventilatory support
- Part 4.7 Weaning ventilatory support
  - Chapter 102 Assessment and technique of weaning
  - Chapter 103 Weaning failure in critical illness
- Part 4.8 Extracorporeal support
  - Chapter 104 Extracorporeal respiratory and cardiac support techniques in the ICU
  - Chapter 105 Treating respiratory failure with extracorporeal support in the ICU
- Part 4.9 Aspiration and inhalation
  - Chapter 106 Aspiration of gastric contents in the critically ill
  - Chapter 107 Inhalation injury in the ICU
- Part 4.10 Acute respiratory distress syndrome
  - Chapter 108 Pathophysiology of acute respiratory distress syndrome
  - Chapter 109 Therapeutic strategy in acute respiratory distress syndrome
- Part 4.11 Airflow limitation
- Part 4.12 Respiratory acidosis and alkalosis
  - Chapter 113 Pathophysiology and therapeutic strategy of respiratory acidosis
  - Chapter 114 Pathophysiology and therapeutic strategy of respiratory alkalosis
- Part 4.13 Pneumonia
- Part 4.14 Atelectasis and sputum retention
- Part 4.15 Pleural cavity problems
- Part 4.16 Haemoptysis
  - Chapter 126 Pathophysiology and causes of haemoptysis
  - Chapter 127 Therapeutic approach in haemoptysis
Section 5 The cardiovascular system
- Part 5.1 Physiology
  - Chapter 128 Normal physiology of the cardiovascular system
- Part 5.2 Cardiovascular monitoring
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
  - Chapter 148 Pathophysiology, diagnosis, and management of aortic dissection
- Part 5.5 The hypotensive patient
  - Chapter 149 Pathophysiology of shock
  - Chapter 150 Diagnosis and management of shock in the ICU
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
  - Chapter 155 Causes and diagnosis of tachyarrhythmias
  - Chapter 156 Therapeutic strategy in tachyarrhythmias
- Part 5.8 Bradyarrhythmias
  - Chapter 157 Causes, diagnosis, and therapeutic strategy in bradyarrhythmias
- Part 5.9 Valvular problems
  - Chapter 158 Causes and diagnosis of valvular problems
  - Chapter 159 Therapeutic strategy in valvular problems
- Part 5.10 Endocarditis
  - Chapter 160 Pathophysiology and causes of endocarditis
  - Chapter 161 Prevention and treatment of endocarditis
- Part 5.11 Severe hypertension
  - Chapter 162 Pathophysiology and causes of severe hypertension
  - Chapter 163 Management of severe hypertension in the ICU
- Part 5.12 Severe capillary leak
  - Chapter 164 Pathophysiology of severe capillary leak
  - Chapter 165 Management of acute non-cardiogenic pulmonary oedema
- Part 5.13 Pericardial tamponade
  - Chapter 166 Pathophysiology and causes of pericardial tamponade
  - Chapter 167 Management of pericardial tamponade
- Part 5.14 Pulmonary hypertension
  - Chapter 168 Pathophysiology and causes of pulmonary hypertension
  - Chapter 169 Diagnosis and management of pulmonary hypertension
- Part 5.15 Pulmonary embolus
  - Chapter 170 Pathophysiology and causes of pulmonary embolism
  - Chapter 171 Diagnosis and management of pulmonary embolism
Section 6 The gastrointestinal system
- Part 6.1 Physiology
  - Chapter 172 Normal physiology of the gastrointestinal system
  - Chapter 173 Normal physiology of the hepatic system
- Part 6.2 Gastrointestinal monitoring
  - Chapter 174 Imaging the abdomen in the critically ill
  - Chapter 175 Hepatic function in the critically ill
- Part 6.3 Gastrointestinal haemorrhage
- Part 6.4 Disordered gastric motility
- Part 6.5 The acute abdomen in the ICU
- Part 6.6 Pancreatitis
  - Chapter 190 Pathophysiology, diagnosis, and assessment of acute pancreatitis
  - Chapter 191 Management of acute pancreatitis in the critically ill
- Part 6.7 Jaundice
  - Chapter 192 Pathophysiology and causes of jaundice in the critically ill
  - Chapter 193 Management of jaundice in the critically ill
- Part 6.8 Acute hepatic failure
- Part 6.9 Acute on chronic hepatic failure
  - Chapter 199 Pathophysiology, diagnosis, and assessment of acute or chronic hepatic failure
  - Chapter 200 Management of acute or chronic hepatic failure in the critically ill
Section 7 Nutrition
- Part 7.1 Physiology
  - Chapter 201 Normal physiology of nutrition
  - Chapter 202 The metabolic and nutritional response to critical illness
- Part 7.2 Nutritional failure
Section 8 The renal system
- Part 8.1 Physiology
  - Chapter 208 Normal physiology of the renal system
- Part 8.2 Renal monitoring and risk prediction
  - Chapter 209 Monitoring renal function in the critically ill
  - Chapter 210 Imaging the urinary tract in the critically ill
- Part 8.3 Oliguria and acute kidney injury
- Part 8.4 Renal replacement techniques
- Part 8.5 Established renal failure
  - Chapter 217 The effect of renal failure on drug handling in critical illness
  - Chapter 218 The effect of chronic renal failure on critical illness
Section 9 The neurological system
- Part 9.1 Anatomy and physiology
  - Chapter 219 Normal anatomy and physiology of the brain
  - Chapter 220 Normal anatomy and physiology of the spinal cord and peripheral nerves
- Part 9.2 Neurological monitoring
- Part 9.3 Sleep disturbance
  - Chapter 225 Pathophysiology and therapeutic strategy for sleep disturbance in the ICU
- Part 9.4 Agitation, confusion, and delirium
  - Chapter 226 Causes and epidemiology of agitation, confusion, and delirium in the ICU
  - Chapter 227 Assessment and therapeutic strategy for agitation, confusion, and delirium in the ICU
- Part 9.5 The unconscious patient
- Part 9.6 Seizures
  - Chapter 231 Pathophysiology and causes of seizures
  - Chapter 232 Assessment and management of seizures in the critically ill
- Part 9.7 Intracranial hypertension
  - Chapter 233 Causes and management of intracranial hypertension
- Part 9.8 Stroke
- Part 9.9 Non-traumatic subarachnoid haemorrhage
  - Chapter 238 Epidemiology, diagnosis, and assessment on non-traumatic subarachnoid haemorrhage
  - Chapter 239 Management of non-traumatic subarachnoid haemorrhage in the critically ill
- Part 9.10 Meningitis and encephalitis
  - Chapter 240 Epidemiology, diagnosis, and assessment of meningitis and encephalitis
  - Chapter 241 Management of meningitis and encephalitis in the critically ill
- Part 9.11 Non-traumatic spinal injury
  - Chapter 242 Pathophysiology, causes, and management of non-traumatic spinal injury
- Part 9.12 Neuromuscular syndromes
Section 10 The metabolic and endocrine systems
- Part 10.1 Physiology
  - Chapter 249 Normal physiology of the endocrine system
- Part 10.2 Electrolyte disturbance
- Part 10.3 Metabolic acidosis and alkalosis
- Part 10.4 Blood glucose control
- Part 10.5 Endocrine disorders
Section 11 The haematological system
- Part 11.1 Laboratory monitoring
  - Chapter 265 The blood cells and blood count
  - Chapter 266 Coagulation monitoring
- Part 11.2 Haematological therapies
  - Chapter 267 Blood product therapy in the ICU
  - Chapter 268 Apheresis in the ICU
- Part 11.3 Disordered coagulation
- Part 11.4 Disorders of the blood cells
Section 12 The skin and connective tissue
- Part 12.1 Skin and connective tissue disorders
- Part 12.2 Wound and pressure sore management
  - Chapter 279 Principles and prevention of pressure sores in the ICU
  - Chapter 280 Dressing techniques for wounds in the critically ill
Section 13 Infection
- Part 13.1 Diagnosis and surveillance
  - Chapter 281 Microbiological surveillance in the critically ill
  - Chapter 282 Novel biomarkers of infection in the critically ill
- Part 13.2 Nosocomial infection
- Part 13.3 Infection in the immunocompromised
  - Chapter 290 Drug-induced depression of immunity in the critically ill
  - Chapter 291 HIV in the critically ill
- Part 13.4 Tropical diseases
- Part 13.5 Sepsis
Section 14 Inflammation
- Part 14.1 Physiology
  - Chapter 299 Innate immunity and the inflammatory cascade
- Part 14.2 Organ-specific biomarkers
- Part 14.3 Host response
- Part 14.4 Anaphylaxis
  - Chapter 314 Pathophysiology and management of anaphylaxis in the critically ill
Section 15 Poisoning
- Part 15.1 Principles of management
  - Chapter 315 Role of toxicology assessment in poisoning
  - Chapter 316 Decontamination and enhanced elimination of poisons
- Part 15.2 Management of specific poisons
Section 16 Trauma
- Part 16.1 Multiple trauma
- Part 16.2 Ballistic trauma
  - Chapter 339 Pathophysiology of ballistic trauma
  - Chapter 340 Assessment and management of ballistic trauma
- Part 16.3 Traumatic brain injury
- Part 16.4 Spinal cord injury
  - Chapter 344 Assessment and immediate management of spinal cord injury
  - Chapter 345 Ongoing management of the tetraplegic patient in the ICU
- Part 16.5 Burns
  - Chapter 346 Pathophysiology and assessment of burns
  - Chapter 347 Management of burns in the ICU
Section 17 Physical disorders
- Part 17.1 Drowning
  - Chapter 348 Pathophysiology and management of drowning
- Part 17.2 Electrocution
  - Chapter 349 Pathophysiology and management of electrocution
- Part 17.3 Altitude- and depth-related disorders
  - Chapter 350 Pathophysiology and management of altitude-related disorders
  - Chapter 351 Pathophysiology and management of depth-related disorders
- Part 17.4 Temperature related disorders
- Part 17.5 Rhabdomyolysis
  - Chapter 355 Pathophysiology and management of rhabdomyolysis
Section 18 Pain and sedation
- Part 18.1 Pain
  - Chapter 356 Pathophysiology and assessment of pain
  - Chapter 357 Pain management in the critically ill
- Part 18.2 Sedation
  - Chapter 358 Sedation assessment in the critically ill
  - Chapter 359 Management of sedation in the critically ill
Section 19 General surgical and obstetric intensive care
- Part 19.1 Optimization strategies for the high-risk surgical patient
  - Chapter 360 Identification of the high-risk surgical patient
  - Chapter 361 Peri-operative optimization of the high risk surgical patient
- Part 19.2 General post-operative intensive care
- Part 19.3 Obstetric intensive care
Section 20 Specialized intensive care
- Part 20.1 Specialized surgical intensive care
- Part 20.2 Oncological intensive care
Section 21 Recovery from critical illness
- Part 21.1 In-hospital recovery from critical illness
- Part 21.2 Complications of critical illness
- Part 21.3 Out-of-hospital support after critical illness
Section 22 End-of-life care
- Part 22.1 Withdrawing and withholding treatment
  - Chapter 387 Ethical decision making in withdrawing and withholding treatment
  - Chapter 388 Management of the dying patient
- Part 22.2 Management of the potential organ donor
  - Chapter 389 Beating heart organ donation
  - Chapter 390 Non-heart-beating organ donation
- Part 22.3 Post-mortem diagnosis
  - Chapter 391 Post-mortem examination in the ICU
End Matter
- Index

Disclaimer

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Pathophysiology of coronary syndromes

Chapter:: Pathophysiology of coronary syndromes

Author(s):: Robert M. Bell

DOI:: 10.1093/med/9780199600830.003.0145

The pathophysiology of acute coronary syndromes is characterized by an acute mismatch of blood supply to the myocardium to meet the prevailing metabolic need. By far the commonest aetiology of myocardial ischaemia is coronary artery disease . An inflammatory process that evolves over the period of many decades, coronary artery disease is characterized by the deposition of cholesterol and cholesterol laden macrophages within the intima of the vessel wall. This process can be accelerated by a number of cardiovascular risk factors (smoking, hypertension, hyperlipidaemia, hypercholesterolaemia, diabetes), which can culminate in the formation of the unstable plaque responsible for the emergent presentation of ST-elevation myocardial infarction. This chapter reviews the prolonged inflammatory process responsible for atheroma formation, along with rarer, non-atheroma-related causes of acute coronary syndromes.

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date: 26 February 2021

Edited by Andrew Webb, Derek Angus, Simon Finfer, Luciano Gattinoni, and Mervyn Singer

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Pathophysiology of coronary syndromes

Robert M. Bell