Therapy of acute myocardial infarction without coronary artery atherothrombosis

Myocardial necrosis is a clinical entity that can occur without significant coronary artery stenosis in the conditions of imbalance between myocardial oxygen supply and / or requires : eg. endothelial dysfunction, coronary artery spasm, coronary artery embolization, tachy - arrhythmias, anemia, respiratory insufficiency, hypotension, and hypertension, and many other clinical conditions. Spontaneous coronary artery dissection (SKAD) is generally considered a rare event, which can be fatal if not been detected and treated in time. It represents an uncommon cause of acute coronary syndrome, which is not associated with a classical risk factors. Myocardial bridge is defined as a epicardial coronary arteries congenital anomaly. whose main characteristic is systolic compression of its intramiocardial segment with a greater or lesser degree of functional (dynamic) lumen narrowing. Prolonged spasm of the coronary arteries can cause endothelium damage, reduce activity of endothelial nitric oxide, vasoactive substances release and platelet aggregation with local thrombus formation. This proves that the coronary artery spasm plays an important role in the pathogenesis of not only vasospastic angina, but also of acute myocardial infarction and sudden cardiac death.