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  Indian J Med Microbiol
 

Figure 1: Depicts the myocardial ischemic cascade and stepwise changes, which occur at molecular and tissue level. Acute coronary syndrome is typically initiated with acute plaque rupture and subsequent intracoronary thrombus development. These changes happen when epicardial coronary flow is interrupted and leads to an imbalance between myocardial oxygen supply and demand, reduced myocardial perfusion, regional ventricular dysfunction, and ST-segment changes and finally angina pectoris, which when severe, results in myocardial ischemia. If this condition is prolonged, myocardial necrosis occurs. Therefore diagnostic techniques that can identify earlier components of this pathway, such as myocardial perfusion imaging have the potential for allowing earlier identification. The characteristic electrocardiogram changes in repolarization are noted 20-30 s after a coronary occlusion. Reduction in myocardial blood flow is the first detectable event in the ischemic cascade, while clinical anginal symptoms are the last in the temporal sequence of the ischemic cascade. Myocardial troponin usually rises by 8-24 h after surgery

Figure 1: Depicts the myocardial ischemic cascade and stepwise changes, which occur at molecular and tissue level. Acute coronary syndrome is typically initiated with acute plaque rupture and subsequent intracoronary thrombus development. These changes happen when epicardial coronary flow is interrupted and leads to an imbalance between myocardial oxygen supply and demand, reduced myocardial perfusion, regional ventricular dysfunction, and ST-segment changes and finally angina pectoris, which when severe, results in myocardial ischemia. If this condition is prolonged, myocardial necrosis occurs. Therefore diagnostic techniques that can identify earlier components of this pathway, such as myocardial perfusion imaging have the potential for allowing earlier identification. The characteristic electrocardiogram changes in repolarization are noted 20-30 s after a coronary occlusion. Reduction in myocardial blood flow is the first detectable event in the ischemic cascade, while clinical anginal symptoms are the last in the temporal sequence of the ischemic cascade. Myocardial troponin usually rises by 8-24 h after surgery