Non-Atherosclerotic Causes of Acute Coronary Syndrome
and Management of The Patients

Yusuf I Alihanoglu; I Dogu Kilic; Bekir S Yildiz

doi:10.29333/ejgm/82300

Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients

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Yusuf I Alihanoglu ¹ ^* , I Dogu Kilic ¹, Bekir S Yildiz ²

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¹ Pamukkale University, Medical Faculty, Department of Cardiology, Denizli, Turkey² Denizli State Hospital, Department of Cardiology, Denizli, Turkey^* Corresponding Author

Abstract

Acute coronary syndromes (ACS) are one of the leading causes of death and morbidity in industrialized countries. Typical presentation includes acute chest pain, cardiac troponin elevation and possibly associated electrocardiogram abnormalities. In great majority of the cases, myocardial infarction (MI) is due to atherosclerosis, usually with plaque rupture and consequent vessel occlusion. However, a minority of patients may suffer an MI for a range of other rare reasons such as coronary vasospasm, coronary thrombosis in situ or embolization from a distal source, hypercoagulable states, spontaneous coronary dissection, some coronary anomalies including coronary bridges and inflammatory states.

Keywords

acute coronary syndrome
non-atherosclerosis
myocardial bridge

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Article Type: Review Article

EUR J GEN MED, Volume 10, Issue Supplement 1, 2013, 22-31

https://doi.org/10.29333/ejgm/82300

Publication date: 09 Jan 2013

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References

Maseri A, Severi S, Nes MD, et al. Variant angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol 1978;42:1019–35
Ginsburg R, Schroeder JS, Harrison DC. Coronary artery spasm––pathophysiology, clinical presentations, diagnostic approaches and rational treatment. West J Med 1982;136:398-410
Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345: 351–8.
Minor RL Jr, Scott BD, Brown DD, Winniford MD. Cocaineinduced myocardial infarction in patients with normal coronary arteries. Ann Intern Med 1991; 115: 797–806.
Williams MJ, Restieaux NJ, Low CJ. Myocardial infarction in young people with normal coronary arteries. Heart 1998; 79: 191–4.
Dimmitt SB, Beilin LJ, Hockings BE. Verapamil withdrawal as a possible cause of myocardial infarction in a hypertensive woman with a normal coronary angiogram. Med J Aust 1988; 49: 218.
Kozeny GA, Ragona BP, Bansal VK, et al. Myocardial infarction with normal results of coronary angiography following diltiazem withdrawal. Am J Med 1986; 80:1184–6.
Yamagishi M, Miyatake K, Tamai J, Nakatani S, Koyama J, Nissen SE. Intravascular ultrasound detection of atherosclerosis at the site of focal vasospasm in angiographically normal or minimally narrowed coronary segments. J Am Coll Cardiol 1994;23:352–7.
Amant C, Hamon M, Bauters C et al. The angiotensin II type 1 receptor gene polymorphism is associated with coronary artery vasoconstriction. J Am Coll Cardiol 1997; 29: 486–90.
Meierhenrich R, Carlsson J, Brockmeier J, Miketic S, Sorges E, Tebbe U. Acute myocardial infarction in patients with angiographically normal coronary arteries: clinical features and medium term follow-up. Z Kardiol 2000; 89:36–42.
Gehani AA, al-Mulla AW, Chaikhouni A et al. Myocardial infarction with normal coronary angiography compared with severe coronary artery disease without myocardial infarction: the crucial role of smoking. J Cardiovasc Risk 2001;8:1–8.
Tun A, Khan IA. Acute myocardial infarction with angiographically normal coronary arteries. Heart Lung 2000; 29: 348–50.
Kawano H, Ogawa H. Endothelial function and coronary spastic angina. Intern Med 2005; 44: 91–9.
Nitenberg A, Antony I, Foult JM. Acetylcholine-induced coronary vasoconstriction in young, heavy smokers with normal coronary arteriographic findings. Am J Med 1993; 95: 71–7.
Kugiyama K, Yasue H, Okumura K, et al. Nitric oxide activity is deficient in spasm arteries of patients with coronary spastic angina. Circulation 1996;94:266–71.
Halcox JP, Schenke WH, Zalos G, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation 2002; 106: 653–8.
Stern S, Bayes de Luna A. Coronary artery spasm: a 2009 update. Circulation 2009;119:2531-4.
DeLoughery TG. Coagulation abnormalities and cardiovascular disease. Curr Opin Lipidol 1999; 10: 443–8.
Braunstein JB, Kershner DW, Bray P, et al. Interaction of hemostatic genetics with hormone therapy: new insights to explain arterial thrombosis in postmenopausal women. Chest 2002; 121: 906–20.
Anderson TJ. Assessment and treatment of endothelial dysfunction in humans. J Am Coll Cardiol 1999; 34: 631–8.
Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004; 43: 1731–7.
Deb A, Caplice NM. Lipoprotein(a): new insights into mechanisms of atherogenesis and thrombosis. Clin Cardiol 2004; 27: 258–64.
Ammann P, Marschall S, Kraus M, et al. Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries. Chest 2000; 117: 333–8.
Dacosta A, Tardy-Poncet B, Isaaz K, et al. Prevalence of factor V Leiden (APCR) and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries. Heart 1998; 80: 338–40.
Lande G, Dantec V, Trossaert M, Godin JF, Le Marec H. Do inherited prothrombotic factors have a role in myocardial infarction with normal coronary arteriogram? J Intern Med 1998; 244: 543–4.
Sadiq A, Ahmed S, Karim A, Spivak J, Mattana J. Acute myocardial infarction: a rare complication of protein C deficiency. Am J Med 2001; 110: 414.
Peterman MA, Roberts WC. Syndrome of protein C deficiency and anterior wall acute myocardial infarction at a young age from a single coronary occlusion with otherwise normal coronary arteries. Am J Cardiol 2003; 92: 768–70.
Menge H, Faig HG, Lang A, Fahrenkrog U, Lollgen H. Homozygous form of factor V Leiden mutation as the cause of a myocardial infarction in patient with an unremarkable coronary vascular system? Dtsch Med Wochenschr 2001; 126:684–6.
Alihanoglu YI, Alur I, Yildiz BS, Esin F, Bilge A. Myocardial Infarction in Young Female Patient Using Oral Contraseptives and Combination of Factor V Leiden Mutation. Journal of Academic Emergency Medicine. 2012 Article in pres. Ref. No:95967
Mansourati J, Da Costa A, Munier S et al. Prevalence of factor V Leiden in patients with myocardial infarction and normal coronary angiography. Thromb Haemost 2000; 83: 822–5.
Van de Water NS, French JK, Lund M, Hyde TA, White HD, Browett PJ. Prevalence of factor V Leiden and prothrombin variant G20210A in patients age <50 years with no significant stenoses at angiography three to four weeks after myocardial infarction. J Am Coll Cardiol 2000; 36: 717–22.
Rallidis LS, Belesi CI, Manioudaki HS, et al. Myocardial infarction under the age of 36: prevalence of thrombophilic disorders. Thromb Haemost 2003; 90: 272–8.
Da Costa A, Tardy B, Haouchette K, et al. Long term prognosis of patients with myocardial infarction and normal coronary angiography: impact of inherited coagulation disorders. Thromb Haemost 2004; 91: 388–93.
Al-Obaidi MK, Philippou H, Stubbs PJ, et al. Relationships between homocysteine, factor VIIa, and thrombin generation in acute coronary syndromes. Circulation 2000; 101: 372–7.
Ogawa M, Abe S, Saigo M, et al. Homocysteine and hemostatic disorder as a risk factor for myocardial infarction at a young age. Thromb Res 2003; 109: 253–8.
Steele P, Rainwater J, Vogel R. Abnormal platelet survival time in men with myocardial infarction and normal coronary arteriogram. Am J Cardiol 1978; 41: 60–2.
Schindler AE. Differential effects of progestins on hemostasis. Maturitas 2003; 46(Suppl. 1):S31–7.
Faraday N, Goldschmidt-Clermont PJ, Bray PF. Gender differences in platelet GPIIb-IIIa activation. Thromb Haemost 1997; 77: 748–54.
Khetawat G, Faraday N, Nealen ML, et al. Human megakaryocytes and platelets contain the estrogen receptor beta and androgen receptor (AR): testosterone regulates AR expression. Blood 2000; 95: 2289–96.
Raymond R, Lynch J, Underwood D, Leatherman J, Razavi M. Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients. J Am Coll Cardiol 1988; 11: 471–7.
Brecker SJ, Stevenson RN, Roberts R, Uthayakumar S, Timmis AD, Balcon R. Acute myocardial infarction in patients with normal coronary arteries. BMJ 1993; 307: 1255–6.
Radomski MW, Moncada S. The biological and pharmacological role of nitric oxide in platelet function. Adv Exp Med Biol 1993; 344: 251–64.
Allen RA, Kluft C, Brommer EJ. Acute effect of smoking on fibrinolysis: increase in the activity level of circulating extrinsic (tissue-type) plasminogen activator. Eur J Clin Invest 1984; 14: 354–61.
Verheugt FW, ten Cate JW, Sturk A, et al. Tissue plasminogen activator activity and inhibition in acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol 1987; 59: 1075–9.
Hamsten A, Wiman B, de Faire U, Blomback M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985;313:1557–63.
Hamsten A, Blomback M, Wiman B et al. Haemostatic function in myocardial infarction. Br Heart J 1986;55: 58–66.
Ichiki K, Ikeda H, Haramaki N, Ueno T, Imaizumi T. Longterm smoking impairs platelet-derived nitric oxide release. Circulation 1996; 94:3109–14.
Celermajer DS, Sorensen KE, Georgakopoulos D, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993; 88: 2149–55.
Kiowski W, Linder L, Stoschitzky K, et al. Diminished vascular response to inhibition of endothelium-derived nitric oxide and enhanced vasoconstriction to exogenously administered endothelin-1 in clinically healthy smokers. Circulation 1994; 90: 27–34.
Graziani MS, Zanolla L, Righetti G, et al. Lipoprotein(a) concentrations are increased in patients with myocardial infarction and angiographically normal coronary arteries. Eur J Clin Chem Clin Biochem 1993;31:135–7.
Sorensen KE, Celermajer DS, Georgakopoulos D, Hatcher G, Betteridge DJ, Deanfield JE. Impairment of endotheliumdependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein(a) level. J Clin Invest 1994;93:50–5.
Stein JH, Rosenson RS. Lipoprotein Lp(a) excess and coronary heart disease. Arch Intern Med 1997;157: 1170–6.
Juhan-Vague I, Pyke SD, Alessi MC, Jespersen J, Haverkate F, Thompson SG. Fibrinolytic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. ECAT Study Group. European Concerted Action on Thrombosis and Disabilities. Circulation 1996; 94: 2057–63.
Thogersen AM, Jansson JH, Boman K, et al. High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women: evidence for the fibrinolytic system as an independent primary risk factor. Circulation 1998; 98: 2241–7.
Miyao Y, Fujimoto K, Kugiyama K, et al. Plasminogen activator inhibitor contributes to the coronary wall thickening in patients with angiographically normal coronary. Thromb Res 2003; 112: 123–9.
Rosendaal FR, Vessey M, Rumley A, et al. Hormonal replacement therapy, prothrombotic mutations and the risk of venous thrombosis. Br J Haematol. 2002;116:851– 854.
ACC/AHA Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–STElevation Myocardial Infarction). ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. Circulation. 2007;116:e148–e304.
Andreotti F, Testa L, Biondi-Zoccai GG, Crea F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J. 2006; 27:519 –526.
Galiuto L, Enriquez-Sarano M, Reeder GS, et al. Eosinophilic myocarditis manifesting as myocardial infarction: early diagnosis and successful treatment. Mayo Clin Proc 1997; 72: 603–10.
Prizel KR, Hutchins GM, Bulkley BH. Coronary artery embolism and myocardial infarction. Ann Intern Med 1978; 88: 155– 61.
Yutani C, Imakita M, Ueda-Ishibashi H, Katsuragi M, Fujita H. Coronary artery embolism with special reference to invasive procedures as the source. Mod Pathol 1992; 5: 244–9.
Dollar AL, Pierre-Louis ML, McIntosh CL, Roberts WC. Extensive multifocal myocardial infarcts from cloth emboli after replacement of mitral and aortic valves with cloth-covered, caged-ball prostheses. Am J Cardiol 1989; 64: 410–2.
Ackermann DM, Hyma BA, Edwards WD. Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature. Hum Pathol 1987; 18: 955–9.
Kraus PA, Lipman J. Coronary embolism causing myocardial infarction. Intensive Care Med 1990; 16: 215–6.
Obarski TP, Loop FD, Cosgrove DM, Lytle BW, Stewart WJ. Frequency of acute myocardial infarction in valve repairs versus valve replacement for pure mitral regurgitation. Am J Cardiol 1990; 65: 887–90.
Doty JR, Wilentz RE, Salazar JD, Hruban RH, Cameron DE. Atheroembolism in cardiac surgery. Ann Thorac Surg 2003; 75: 1221–1226.
Sharifi M, Frohlich TG, Silverman IM. Myocardial infarction with angiographically normal coronary arteries. Chest 1995; 107: 36–40.
Freed LA, Benjamin EJ, Levy D, et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol 2002; 40: 1298–304.
Theal M, Sleik K, Anand S, Yi Q, Yusuf S, Lonn E. Prevalence of mitral valve prolapse in ethnic groups. Can J Cardiol 2004; 20: 511–5.
Crump R, Shanding AH, Van Natta B, Ellestad M. Prevalence of patent foramen ovale in patients with acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol 2000; 85: 1368–1370.
Carano N, Agnetti A, Hagler DJ, Tchana B, Squarcia U, Bernasconi S. Acute myocardial infarction in a child: possible pathogenic role of patent foramen ovale associated with heritable thrombophilia. Pediatrics 2004; 114: e255–8.
Ross R. Atherosclerosis–an inflammatory disease. N Engl J Med 1999; 340: 115–26.
Rifai N, Ridker PM. High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease. Clin Chem 2001; 47: 403–11.
Cannon CP, Braunwald E, McCabe CH, et al. Antibiotic treatment of Chlamydia pneumoniae after acute coronary syndrome. N Engl J Med 2005; 352: 1646–54.
Korkmaz C, Cansu DU, Kasifoglu T. Myocardial infarction in young patients (\ or = 35 years of age) with systemic lupus erythematosus: a case report and clinical analysis of the literature. Lupus 2007; 16: 289–297.
Cocco G, Gasparyan AY Myocardial ischemia in Wegener’s granulomatosis: coronary atherosclerosis versus vasculitis. Open Cardiovasc Med J 2010; 4:57–62.
Rangel A, Lavalle C, Chavez E, et al. Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis– case reports. Angiology 1999; 50: 245–53.
Bukiej A, Dropinski J, Rys D, Musial J. Myocardial infraction as the first manifestation of systemic lupus erythematosus in a 22-year-old man. Pol Arch Med Wewn2004;111:213–6.
Luca NJ, Yeung RS. Epidemiology and management of Kawasaki disease. Drugs 2012 May 28;72(8):1029-38.
Bac DJ, Lotgering FK, Verkaaik AP, Deckers JW. Spontaneous coronary artery dissection during pregnancy and postpartum. Eur Heart J 1995;16:136–8.
Badmanaban B, McCarty D, Mole DJ, McKeown PP, Sarsam MA. Sponataneous coronary artery dissection presenting as cardiac tamponade. Ann Thorac Surg 2002;73:1324–6.
Thistlethwaite PA, Trazi RY, Giordano FJ, Jamieson SW. Surgical management of spontaneous left main coronary artery dissection. Ann Thorac Surg 1998;66:258–60.
Aliyary S, Mariani MA, Verhorst PM, Hartmann M, Stoel MG, von Birgelen C. Staged therapeutic approach in spontaneous coronary dissection. Ann Thorac Surg 2007;83:1879-81.
Kearney P, Singh H, Hutter J, Khan S, Lee G, Lucey J. Spontaneous coronary artery dissection: a report of three cases and review of the literature. Postgrad Med J 1993;69:940–5.
Madu EC, Kosinski DJ, Wilson WR, Burket MW, Fraker TD Jr, Ansel GM. Two-vessel coronary artery dissection in the peripartum period. Case report and literature review. Angiology 1994; 45: 809–16.
Kamineni R, Sadhu A, Alpert JS. Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature. Cardiol Rev 2002; 10: 279–84.
Pretty HC. Dissecting anneurysm of coronary artery in a woman aged 42; rupture. BMJ 1931;1:667.
Jorgensen MB, Aharonian V, Mansukhani P, Mahrer PR. Spontaneous coronary artery dissection: A cluster of cases with this rare finding. Am Heart J 1994;127:1382–7.
Heefner WA. Dissection haematoma of the coronary artery. JAMA 1973;223:550–1
Koul AK, Hollander G, Moskovits N, Frankel R, Herrera L, Shani J. Coronary artery dissection during pregnancy and the postpartum period: Two case reports and review of literature. Catheter Cardiovasc Interv 2001;52:88–94.
Bager AC, Beeuwkes R, Ainey L, Silverman K. Hypothesis: Vasa vasorum and neovascularisation of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N Engl J Med 1984;310:175–7.
Robinowitz M, Virmani R, McAllister H. Spontaneous coronary artery dissection and eosinophilic inflammation: A cause and effect relationship. Am J Med 1982;72:923–8.
Dowling GP, Buja LM. Spontaneous coronary artery dissection occurs with and without peri-adventitial inflammation. Arch Pathol Lab Med 1987;111:470–2.
Steinhauer JR, Caulfield JB. Spontaneous coronary artery dissection associated with cocaine use: A case report and brief review. Cardiovasc Pathol 2001;10:141–5.
Ellis CJ, Haywood GA, Monro JL. Spontaneous coronary artery dissection in a young woman resulting from intense gymnasium “work-out” Int J Cardiol 1994;47:193–4.
Masuda T, Akiyama H, Kurosawa T, Ohwada T. Long-term follow-up of coronary artery dissection due to blunt chest trauma with spontaneous healing in a young woman. Intensive Care Med 1996;22:450–2.
Borczuk AC, van Hoeven KH, Factor SM. Review and hypothesis: The eosinophil and peripartum heart disease (myocarditis and coronary artery dissection)--coincidence or pathogenetic significance? Cardiovasc Res.1997;33:527– 32.
Bonacchi M, Prifti E, Giunti G, et al. Emergency management of spontaneous coronary artery dissection. J Cardiovasc Surg (Torino) 2002;43:189–93.
Martín Dávila F, Delgado Portela M, García Rojo M, et al. Coronary artery dissection in alpha-1-antitrypsin deficiency. Histopathology 1999;34:376–8.
Azam MN, Roberts DH, Logan WF. Spontaneous coronary artery dissection associated with oral contraceptive use. Int J Cardiol 1995;48:195–8.
Saunders SL. Spontaneous coronary artery dissection possibly related to drug hypersensitivity in a male. Gen Physiol Biophys 1990;9:291–9.
Basso C, Morgagni GL, Thiene G. Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death. Heart 1996; 75: 451–4.
Engelman DT, Thayer J, Derossi J, Scheinerman J, Brown L. Pregnancy related coronary artery dissection: A case report and collective review. Conn Med 1993;57:135–9.
Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: A Western Denmark Heart Registry Study. Catheter Cardiovasc Interv 2009;74:710–7.
Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP. The role of intravascular ultrasound in the management of spontaneous coronary artery dissection. Cardiovasc Ultrasound 2008;6:24.
Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery dissection: Incidence, diagnosis and treatment. Int J Cardiol 2005;101:363–9.
Sarmento-Leite R, Machado PR, Garcia SL. Spontaneous coronary artery dissection: Stent it or wait for healing? Heart 2003;89:164.
Benham R, Tillinghast S. Thrombolytic therapy in spontaneous coronary artery dissection. Clin cardiol 1991;14:611–4.
Almeda F, Barkatullah S, Kavinsky CJ. Spontaneous coronary artery dissection. Clin Cardiol 2004;27:377–80.
Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA Guidelines for the management of patients with STelevation myocardial infarction: Executive summary. J Am Coll Cardiol 2004;44:671–719.
Atay Y, Yagdi T, Turkoglu C, Altintig A, Buket S. Sponatneous dissection of the left main coronary artery: A case report and review of the literature. J Card Surg 1996;11:371–5.
Levin DC, Fellows KE, Abrams HL Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation 1978;58:25–34.
Angelini P Coronary artery anomalies: an entity in search of an identity. Circulation 2007;115:1296–1305.
Irvin RG. The angiographic prevalence of myocardial bridging in man. Chest 1982;81:198–202.
Soran O, Pamir G, Erol C, et al The incidence and significance of myocardial bridge in a prospectively defined population of patients undergoing coronary angiography for chest pain. Tokai J Exp Clin Med 2000;25:57–60.
Alegria JR, Herrmann J, Holmes DR Jr, et al. Myocardial bridging. Eur Heart J 2005; 26:1159–1168.

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Vancouver

Alihanoglu YI, Kilic ID, Yildiz BS. Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients. EUR J GEN MED. 2013;10(Supplement 1):22-31. https://doi.org/10.29333/ejgm/82300

APA

Alihanoglu, Y. I., Kilic, I. D., & Yildiz, B. S. (2013). Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients. European Journal of General Medicine, 10(Supplement 1), 22-31. https://doi.org/10.29333/ejgm/82300

AMA

Alihanoglu YI, Kilic ID, Yildiz BS. Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients. EUR J GEN MED. 2013;10(Supplement 1), 22-31. https://doi.org/10.29333/ejgm/82300

Chicago

Alihanoglu, Yusuf I, I Dogu Kilic, and Bekir S Yildiz. "Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients". European Journal of General Medicine 2013 10 no. Supplement 1 (2013): 22-31. https://doi.org/10.29333/ejgm/82300

Harvard

Alihanoglu, Y. I., Kilic, I. D., and Yildiz, B. S. (2013). Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients. European Journal of General Medicine, 10(Supplement 1), pp. 22-31. https://doi.org/10.29333/ejgm/82300

MLA

Alihanoglu, Yusuf I et al. "Non-Atherosclerotic Causes of Acute Coronary Syndrome and Management of The Patients". European Journal of General Medicine, vol. 10, no. Supplement 1, 2013, pp. 22-31. https://doi.org/10.29333/ejgm/82300

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