0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Ruptured Plaques and Leaking Cells: Cost-Effectiveness in the Diagnosis of Acute Coronary Syndromes

Arthur C. Fox, MD; and Richard I. Levin, MD
[+] Article and Author Information

New York University School of Medicine; New York, NY 10016 (Fox) New York University School of Medicine; New York, NY 10016 (Levin)


Requests for Reprints: Arthur C. Fox, MD, Cardiology Section, New York University School of Medicine, 550 First Avenue, New York, NY 10016; e-mail, arthur.fox@med.nyu.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Fox and Levin: Cardiology Section, New York University School of Medicine, 550 First Avenue, New York, NY 10016.


Ann Intern Med. 1999;131(12):968-970. doi:10.7326/0003-4819-131-12-199912210-00011
Text Size: A A A

Acute coronary syndromes arise when an atherosclerotic plaque becomes unstable. The cap develops either superficial erosions with overlying thrombus or, more commonly, deep fissures that cause the plaque to swell with clotted blood and encroach on the arterial lumen. Plaques become unstable when the fibrous matrix surrounding the lipid core is attenuated by the action of cytokines from T lymphocytes, which inhibit the synthesis of the matrix, and by metalloproteinases from activated macrophages, which degrade the matrix. The cause of the initial surface breach of the weakened cap may be chemical, caused by reactive oxygen species, or mechanical, caused by focal stresses. The consequent growing fault may reach the plaque center; the resulting acute eruption of the lipid core amplifies local thrombosis. Abrupt occlusion of an artery unprotected by recruitable collaterals leads to acute regional ischemia. Complete and persistent occlusion produces myocardial infarction. Partial occlusion or occlusion that waxes and wanes results in unstable angina. Plaques can be multiple or single, regress, develop recurrent instability, or remain dormant for years (13). Study of the unstable plaque thus resembles volcanology and plate tectonics; the detection of clinical and biological markers of plaque instability, ischemia, and infarction is like seismography.

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)