Highlights & Basics
- Unstable angina (UA) should be suspected based on: the presence of symptoms suggestive of myocardial ischemia (e.g., acute chest pain); ECG findings (no evidence of ST-elevation myocardial infarction); and the result of troponin testing (no dynamic elevation of cardiac troponin (hs-cTn) above the 99th percentile).
- A resting 12-lead ECG should be recorded and interpreted within 10 minutes of the point of first medical contact in any patient with suspected unstable angina (and other acute coronary syndromes [ACS]).
- In patients with suspected ACS, nonelevated (or uncertain) hs-cTn levels, no ECG changes and no recurrence of pain, a noninvasive stress imaging test or coronary computed tomography angiograph (CCTA) should be considered as part of initial evaluation.
- Acute management includes antiplatelet and anticoagulant therapy to reduce the extent of myocardial damage and complications. Further management is based on the results of troponin testing and risk assessment. This may include dual antiplatelet therapy and an invasive strategy or noninvasive investigation.
- Long-term management should aim to modify risk factors for cardiovascular disease and use of drug to prevent recurrence.
Quick Reference
History & Exam
Key Factors
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
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