Ulcerated Plaques (UP)
August 01, 2011
Shown here is an x-ray of a portion of the coronary artery and a microscopic section taken through this area in a 38 year-old man who died sudden cardiac death. The small pocket off the channel seen on the x-ray (arrow) can be seen on the microscopic slide. This pocket is a tiny rupture of a small plaque that does not cause any narrowing of the artery channel which is filled with colored material which we injected to properly study this heart. We call this tiny rupture an “ulcerated plaque” or an open sore within the coronary artery. Why am I showing this and what is its significance?
First of all this UP was not the cause of death in this patient, but was an incidental finding when we thoroughly looked at all the coronary arteries. Second, we do not know the age of this UP because we cannot determine the age by looking in the microscope. It could be days, weeks, months or even years old. Third, we know many plaques that rupture and cause heart attacks were relatively small and were not causing any significant obstruction of flow on prior coronary angiograms. The tiny UP shown here cannot be seen on an angiogram on a live patient. Therefore the presence of such UP’s cannot be identified in the live patient.
The importance of the UP shown here is that it is potentially unstable. That is, since it is exposed to flowing blood while the patient is still alive, it is potentially unstable and could progress rapidly by developing a blood clot, obstructing the flow of blood and cause a heart attack. This could explain the rapid progression of a seemingly small and insignificant plaque noted on angiograms of live patients.
We need to be able to identify UP’s of this type and institute preventive measures if we want to prevent heart attacks and sudden cardiac death. In our studies, approximately 20% of all UP’s are associated with <50% narrowing of the artery channel and do not contain blood clot.
|
| Acute Myocardial Infarction is complicated by, not caused by, Ischemia
June 05, 2006
|
| Cholesterol crystals and plaque fissure.
November 26, 2007
|
| Coronary calcification
December 03, 2007
|
| Exit Tracts
August 03, 2011
|
| Is Atherosclerosis Caused By A Single Infectious Agent?
June 05, 2006
|
| Multiple acute syndromes, but only one substrate. Why?
June 05, 2006
|
| Sudden Cardiac Death May Not Be Caused By Ischemia
April 17, 2008
|
| Ulcerated Plaques (UP)
August 01, 2011
|
|
