This is a representative video of coronary angiography. While it does not display<unk> , it highlights the technique used to identify the condition. Given the demographics of<unk> , it is important to maintain a high index of suspicion for the condition in otherwise low-risk women presenting with symptoms of acute coronary syndrome. Initial evaluation may show ECG changes of ST elevation, like heart attacks due to other causes.<unk>  comprises 2-4% of all cases of acute coronary syndrome. With typically elevated cardiac biomarkers and ECG changes, people will often undergo coronary angiography evaluation. It is important to recognize<unk>  through angiography as other confirmatory measures carry increased risks. Angiography There are 3 types of<unk>  based on angiographic and anatomical criteria; with the designations based on the location and extent of the hematoma within the walls of the coronary<unk> es. Type 1<unk>  results from an intimal tear of the coronary<unk>  (a tear of the innermost layer of the<unk> al wall) creating a false lumen as blood flows into the new space. A type 1<unk>  lesion is seen on angiography or intravascular imaging as a radiolucent flap separating the two flow channels; separating the false lumen from the true lumen of the coronary<unk> . Type 2<unk> , the most common type of<unk>  lesions, seen in 60-75% of patients, occurs due to an intramural hematoma or a collection of blood in the muscular layer of the coronary<unk>  wall with the absence of intimal tearing. This is seen on coronary angiography as an abrupt change in coronary caliber with a long segment of a diffusely narrowed<unk>  (typically longer than 20 mm). Type 2<unk>  is subdivided into type 2A where the narrowed segment of the coronary<unk>  is flanked by normal caliber segments and type 2B where the stenosis continues to the terminus of a coronary<unk> . Type 3<unk> , the least common type, is also due to an intramural hematoma causing coronary stenosis, but the lesions are shorter than as seen in type 2<unk> , being less than 20 mm in length. Due to the short segment of coronary stenosis in type 3<unk> , it is often difficult to differentiate type 3<unk>  lesions from coronary stenosis due to atherosclerotic plaques and intra-coronary imaging is often needed to distinguish between the two. Some authors have proposed a fourth designation of<unk> , type 4<unk> , in which there is a complete intraluminal occlusion of the coronary<unk>  due to any of the previously mentioned types (Type 1-3). Intracoronary imaging This is a representative image of two types of intracoronary imaging, OCT (left) and IVUS (right). Intracoronary imaging (ICI), consisting of intracoronary optical coherence tomography (OCT) and intravascular ultrasound (IVUS) can help distinguish<unk>  from an atherosclerotic lesion when it is difficult to do so with angiography. ICI techniques provide a direct view of the walls of the coronary<unk>  to confirm<unk> , but may actually worsen the<unk>  as the probes are inserted into the damaged area. ICI confers a 3.4% risk of iatrogenic<unk>  in people with<unk>  compared to 0.2% risk in the general population. Between the two ICI methods, OCT - a newer technique - has superior spatial resolution than IVUS and is the preferred technique if ICI is required, but the need to inject extra contrast with OCT poses risk for worsening the<unk> . Other methods Some studies propose coronary CT angiography to evaluate<unk>  in lower-risk people, with research into the approach ongoing.
Spontaneous coronary artery dissection
Subacute bacterial endocarditis
Left ventricular thrombus
Libman–Sacks endocarditis
Coronary artery aneurysm
Nonbacterial thrombotic endocarditis
Coronary steal
Primary ventricular fibrillation