Unstable angina

Medicine > Cardiovascular

Background knowledge 🧠

Definition

Unstable angina is a type of acute coronary syndrome (ACS).
Characterised by increased frequency, duration, or intensity of chest pain.
Occurs at rest or with minimal exertion, may precede myocardial infarction.

Epidemiology

Incidence increases with age, particularly in those over 65.
More common in men than women, especially pre-menopause.
Affects approximately 20% of patients presenting with chest pain.
Risk factors include smoking, hypertension, diabetes, and hyperlipidaemia.

Aetiology and pathophysiology

Typically due to plaque rupture leading to thrombus formation.
May involve coronary artery vasospasm.
Reduced blood flow causing myocardial ischaemia.
Elevated cardiac biomarkers may not always be present.

Types

Rest angina: occurs at rest, unpredictable.
Progressive angina: increasing frequency/intensity.
Post-infarction angina: angina following a myocardial infarction.

Clinical Features 🌡️

Symptoms

Chest pain or discomfort, often described as pressure or squeezing.
Pain may radiate to arms, neck, jaw, or back.
Shortness of breath, fatigue, and nausea may occur.

Signs

Tachycardia or bradycardia may be present.
Blood pressure may vary depending on severity.
Possible signs of heart failure (e.g., pulmonary congestion).

Investigations 🧪

Tests

ECG: may show ST-segment depression or T-wave inversion.
Cardiac biomarkers: troponin may be normal or slightly elevated.
Coronary angiography may be indicated in persistent cases.
Stress testing may be performed if stable.

Management 🥼

Management

Immediate: nitrates, beta-blockers, and antiplatelet therapy.
Long-term: statins and lifestyle modification.
Consider revascularisation (PCI or CABG) based on severity.

Complications

Myocardial infarction.
Heart failure due to prolonged ischaemia.
Arrhythmias as a consequence of ischaemia.

Prognosis

Higher risk of subsequent myocardial infarction.
Mortality rate increases in patients with risk factors.
Timely intervention improves outcomes significantly.

Key points

Recognise unstable angina as a medical emergency.
Early identification and management critical for prognosis.
Emphasise lifestyle modification in prevention.

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