Unstable Angina

Cardiology (12%) Core Clinical Conditions

1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

Jump to content

Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Unstable angina can be defined as a chest pain or discomfort caused by a restriction or reduction in blood flow to the heart. In contrast to stable angina, which is often triggered by physical exertion or stress and is alleviated by rest or medicine, unstable angina can occur during rest or minimal physical activity. Importantly, it may be a sign of an oncoming heart attack; hence, the patient should be admitted to the hospital for evaluation.

Angina is primarily caused by the progression of atherosclerosis. This accumulation of fatty deposits (plaque) narrows the artery and reduces blood flow to the heart.

Unstable Angina happens whenever a plaque ruptures, resulting in the formation of a blood clot that partially or completely obstructs the blood supply to the artery. Chest discomfort is caused by the abrupt reduction in blood flow.

Reduced blood flow to the heart can cause heart muscle damage, which can lead to additional complications such as heart failure, arrhythmias, and even sudden cardiac death.

• Older age individuals 

• Family history

• Smoking

• Hypertension 

• High cholesterol: raised LDL (low-density lipoprotein) cholesterol increases the plaque build up in the coronary arteries.

• Diabetes

• Obesity

• Sedentary lifestyle

• Chest pain 

• Shortness of breath (SOB)

• Perfused sweating

• Nausea/vomiting

• Dizziness 

• Fatigue

• Electrocardiogram 

• Blood tests: check troponin 

• ECHO

• Coronary angiography

• Cardiac magnetic resonance (CMR)

• CXR

Lifestyle changes: 

• Smoking cessation, healthy diet, healthy weight, and increased physical activity

• Encourage reduced alcohol consumption

Medication: 

• Sublingual glyceryl trinitrate (GTN) for rapid relief of symptoms, instruct patient to call an ambulance if pain persists despite use

• Beta-blocker or calcium-channel blocker (CCB) are first-line regular treatment

• Antiplatelet treatment (low-dose aspirin or clopidogrel) and ACE inhibitors are generally used as secondary prevention

• Statin used as adjunct

Referral: 

• Considerer referral to a cardiologist if patient has previous heart conditions + angina symptoms or abnormal ECG, or other risk factors

Procedures: cardiac angioplasty or coronary artery bypass surgery can be considered to improve blood flow to the heart.

Jump to other topics below: