Spectrum of acute coronary syndromes

What it is

Ischemic heart disease falls first into a clinically silent, asymptomatic form and a symptomatic form. The symptomatic side falls again into stable angina on one side and the acute coronary syndromes on the other, so stable angina is symptomatic ischemic heart disease but is not itself an acute coronary syndrome.

The acute coronary syndromes are three:

• Unstable angina
• Non ST-segment elevation MI
• ST-segment elevation MI

Two of the three are named for the ST segment: ST-segment elevation MI, also written ST-elevation myocardial infarction, and non ST-segment elevation MI. Unstable angina is the third.

Causes and risk

All of this sits on the atherosclerotic plaque, shown with the intima and the media. The order is the atherosclerotic plaque itself, then progression of the atherosclerotic plaque, then a ruptured plaque, then thrombosis formation.