Ischemic Heart Disease: Anatomic and Physiologic Considerations

The differential diagnosis of chest pain is vast, as chest pain may originate from the cardiovascular, gastrointestinal, respiratory, musculoskeletal, and nervous systems. Potentially lethal causes of chest pain, which must be considered in every patient with this complaint, include acute myocardial infarction, aortic dissection, pneumothorax, pneumonia, pulmonary embolism, and esophageal perforation. While many presentations of chest pain are not cardiac, the time-sensitive nature as well as dire consequences of missed cardiac chest pain make early consideration and diagnosis of this disease essential. Acute coronary syndromes include unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The pathophysiology of STEMI is very different from that of UA and NSTEMI. The chapter also lists the association of the anatomic cardiac wall with the related coronary artery and imaging electrocardiogram leads.