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I24

Other acute ischaemic heart disease (I24): coronary thrombosis without infarction, Dressler syndrome, diagnosis and prevention.

Other acute ischaemic heart disease (ICD-10 I24) covers acute episodes of insufficient blood supply to the heart muscle that do not meet the criteria for myocardial infarction. It includes coronary thrombosis without infarction, post-infarction (Dressler) syndrome and acute coronary insufficiency. All of them arise from ischaemic (coronary) heart disease: narrowing of the coronary arteries, usually by atherosclerosis, which reduces the blood and oxygen reaching the heart muscle. Ischaemic heart disease is the leading cause of death worldwide, and acute episodes can progress to myocardial infarction or sudden death.

ICD-10 I24Coronary heart diseaseIschaemia

I24.0coronary thrombosis without infarction

I24.1Dressler syndrome

Troponinnormal or not meeting MI criteria

LDL target (high risk)< 1.4 mmol/L (55 mg/dL)

Figure 1. ECG signs of acute myocardial ischaemia: horizontal ST depression (middle) and T-wave inversion (right). The ECG may also be normal between episodes.

How it develops

Atherosclerotic plaques narrow the coronary arteries over years. When oxygen demand rises (exercise, emotion, cold), a narrowed artery cannot increase flow, causing stable angina. If a plaque ruptures and a clot forms, flow can fall suddenly: when this happens without death of heart muscle, the episode is unstable angina or acute ischaemia; when muscle dies, it is myocardial infarction. Dressler syndrome is an immune-mediated inflammation of the pericardium (and sometimes pleura) occurring weeks after infarction or heart surgery, with chest pain worse on breathing and lying down, fever and raised inflammatory markers.

Diagnosis

ECG at rest and during pain; repeated high-sensitivity troponin to exclude infarction
Coronary CT angiography is preferred to rule out obstructive coronary disease in patients with low to moderate probability; stress imaging or invasive angiography in others
Echocardiography; for Dressler syndrome, echo for pericardial effusion and inflammatory markers

Treatment and prevention

Acute episodes are managed like acute coronary syndromes: antiplatelet therapy, anticoagulation, anti-ischaemic medicines and coronary angiography as needed
Long term: aspirin, high-intensity statin with an LDL target below 1.4 mmol/L, control of blood pressure and diabetes, stopping smoking, physical activity, healthy diet and weight
Revascularisation (stent or bypass) when symptoms persist despite medicines or when the anatomy indicates prognostic benefit
Dressler syndrome: anti-inflammatory treatment (aspirin or NSAIDs, colchicine)

Call emergency services immediately

for new chest pain, pain at rest, pain lasting more than a few minutes or angina that is more frequent or severe than usual.

References

Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415–3537. doi:10.1093/eurheartj/ehae177
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. doi:10.1093/eurheartj/ehad191

This article is for general information and does not replace a consultation with a doctor. Diagnosis and treatment must be decided by a physician on the basis of symptoms, examination and tests.

Published on 24 March 2019

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