Triggering and the pathophysiology of acute coronary syndromes.

Insight into the pathophysiology of acute coronary syndromes can be gained by studying the role of triggering activities, such as heavy physical exertion and episodes of anger, in promoting plaque rupture and thrombosis, and the determinants of plaque vulnerability to disruption, which include lipid-rich plaque, a thin fibrous cap, and increased macrophage activity. This article focuses on the contribution of triggering activities and the potential mechanisms by which they may lead to acute myocardial infarction and sudden cardiac death.