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Unstable angina

Background knowledge ๐Ÿง 

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 ๐ŸŒก๏ธ

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 ๐Ÿงช

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 ๐Ÿฅผ

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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