Cardiovascular Medicine Book

Circulatory Disorders

Electrocardiogram

Myocardial Infarction

Symptoms

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Unstable Angina

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  1. See Also
    1. Chest Pain
    2. Angina
    3. Angina Diagnosis
  2. Symptoms
    1. Ongoing Angina-type pain
      1. Despite decreasing level of exertion
      2. With increasing severity or frequency
      3. Rest pain in the last week
      4. Class 3 or 4 Chest Pain
      5. Pain following Myocardial Infarction (over 24 hours)
    2. Varying patterns of radiating pain
    3. History non-q wave Myocardial Infarction
    4. Atypical presentations are common over age 65 (50%)
      1. Atypical Chest Pain or arm, epigastric or neck pain
      2. Shortness of Breath
      3. Diaphoresis
      4. Nausea
      5. Canto (2002) Am J Cardiol 90:248
  3. Signs
    1. Dyskinetic apical impulse
    2. New S3 Gallop rhythm
    3. New S4 Gallop rhythm
    4. New or worsening Mitral Regurgitation murmur
    5. Secondary Congestive Heart Failure
      1. Rales
      2. Hypotension
  4. Differential Diagnosis
    1. Acute Myocardial Infarction
    2. Aortic Dissection
    3. Pericarditis
    4. Cardiac Tamponade
    5. Pneumothorax
    6. Pulmonary Embolus
    7. Peptic Ulcer Disease
    8. Cholecystitis or Cholelithiasis
    9. Esophageal Spasm
    10. Cervical Disc Disease
  5. Electrocardiogram
    1. EKG in Myocardial Ischemia
  6. Management
    1. See Ischemic Chest Pain Management
  7. Indications for angiography in unstable Angina
    1. Failure to stabilize with adequate medical therapy
    2. Recurrent or persistent pain or ischemia
    3. Previous revascularization procedure
    4. Multiple admissions for undiagnosed Chest Pain
    5. High-risk findings on clinical assessment
      1. Congestive Heart Failure
      2. Left Ventricular Dysfunction
      3. Mitral Regurgitation (new or worsening)
      4. Malignant ventricular arrhythmia
      5. Positive Exercise Stress Test or Stress Imaging
  8. Prognosis
    1. See Unstable Angina Prognosis

Unstable angina (C0002965)

Definition (MSH)Precordial pain at rest, which may precede a MYOCARDIAL INFARCTION.
Definition (NCI)Angina pectoris (or equivalent type of ischemic discomfort) which has recently changed in frequency, duration, intensity, or occurs at rest.
Definition (NCI)Angina pectoris (or equivalent type of ischemic discomfort) with any 1 of the 3 following features: a) Angina occurring at rest and prolonged, usually greater than 20 minutes; b) New onset angina of at least Canadian Cardiovascular Society Grading Scale (or CCS classification system) classification severity III or greater; c) Recent acceleration in angina accentuated by an increase in severity of at least 1 CCS class to at least CCS class III. The biomarkers of necrosis are below the threshold of myocardial infarction.
ConceptsDisease or Syndrome (T047)
ICD9411.1, 411.1
MSHD000789
EnglishAngina at Rest, Anginal chest pain at rest, Crescendo angina, Impending infarction, INTERMED CORONARY SYND, Intermediate coronary syndrome, Preinfarction Angina, Preinfarction Anginas, Unstable angina, Unstable Angina Pectoris, Unstable Anginas, Worsening angina
Spanishangina de pecho de reposo, angina inestable, angina preinfarto, infarto inminente, sindrome coronario intermedio
Parent ConceptsOther acute and subacute ischemic heart disease NOS (C0340283), Angina Pectoris (C0002962), Acute ischemic heart disease (C1510446), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesDXP, ICD9CM, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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