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By E.E Payne

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Clin Med Res. 2007;5: 172–6. 16. Wang CH, Kuo LT, Hung MJ, Cherng WJ. Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am Heart J. 2002;144:275–81.  Cardiac arrest and sudden unexpected death in variant angina: complications of coronary spasm that can occur in the absence of severe organic coronary stenosis.  1993;125:1011–7. 18. Zaya M, Mehta PK, Merz CN. Provocative testing for coronary reactivity and spasm.

For this reason angiography, which visualizes only plaques that encroach upon the lumen, will under-represent the extent of atherosclerosis. As the burden of plaque increases the artery can no longer compensate by expanding outward and the plaque begin to protrude into the lumen. This generally occurs when plaque involvement reaches about 40 % of the vessel circumference [16]. As the lipid burden of an atherosclerotic lesion grows the risk of plaque rupture increases. When plaque rupture occurs the lipid core comes into contact with the blood.

Substernal chest discomfort with a characteristic quality and duration 2. Worse with exertion or emotional stress 3. 2 Canadian cardiovascular society grading of angina pectoris Grade 1 Grade 2 Data from Gibbons et al. [1] and Diamond [30] non–ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA). The clinical manifestation of CAD depends on many factors and is heavily influenced by the pathophysiology of the disease process. The most common cause of CAD is atherosclerosis.

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