Each year, approximately 2 million people in the United States experience acute coronary syndromes related to thrombosis and ulceration of atherosclerotic plaque within a coronary artery. The case of Mr C, a 43-year-old man with non–ST-segment elevation myocardial infarction, which is most often caused by subtotal thrombosis, illustrates the complex decision-making process involved in selecting treatment for each patient and in determining whether invasive procedures are warranted. Cardiac catheterization is performed in moderate- and high-risk individuals to define the extent of disease so the proper strategy—medications alone, percutaneous revascularization, or coronary artery bypass graft surgery—can be selected. Medications to disrupt platelet function as well as the coagulation system are used. Treatments are designed to minimize the extent of infarction and prevent reinfarction, thereby improving outcomes. The timing of cardiac catheterization, for whom catheterization is indicated, and the rationale for medication treatment are discussed.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Electrocardiogram (ECG) demonstrates new ST-segment depression and T-wave abnormalities in the lateral leads with ST elevation in leads V1-V3 that was present on prior ECGs.
The figure shows disease at the origin of the left anterior descending artery (LAD) and proximal disease in a large diagonal branch (A) followed by occlusion, diffuse disease, and reconstitution in the distal LAD via collaterals (B) and severe stenosis involving the right coronary artery (arrowhead) (C). LAO indicates left anterior oblique. See the video of the angiography.
Thank you for submitting a comment on this article. It will be reviewed by JAMA editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Contrast Angiography of Mr C's Left and Right Coronary Arteries
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination
Evidence Summary and Review 2
The Rational Clinical Examination
Multivariate Findings for ACI Syndromes
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.