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Unstable Angina Prognosis
Aka: Unstable Angina Prognosis, Unstable Angina Risk
- See Also
- Chest Pain
- Cardiac Risk Factors
- Angina
- Angina Diagnosis
- Unstable Angina
- TIMI Risk Score
- Bosner Chest Pain Decision Rule
- Acute Coronary Syndrome
- Acute Coronary Syndrome Immediate Management
- Acute Coronary Syndrome Adjunctive Therapy
- High Risk Acute Coronary Syndrome Management
- Moderate Risk Acute Coronary Syndrome Management
- Low Risk Acute Coronary Syndrome Management
- Myocardial Infarction Stabilization
- Serum Cardiac Markers
- Electrocardiogram in Myocardial Infarction
- Echocardiogram in Myocardial Infarction
- Goldman Criteria for ICU Chest Pain Admission
- Indications: Assess risk Unstable Angina adverse event
- Risk of Myocardial Infarction or sudden death
- Occurs in near future in patient with Unstable Angina
- Directs Non-diagnostic Electrocadiogram Protocol
- Criteria: High risk
- Ongoing rest Chest Pain >20 minutes
- Age over 75 years
- Clearly elevated Cardiac Markers (e.g. Troponin I)
- New signs of Congestive Heart Failure
- Pulmonary Edema related to suspected ischemia
- New or worsening Mitral Regurgitation murmur
- S3 Gallop
- New or worsening pulmonary rales
- Hypotension
- EKG changes
- New ST segment deviation >0.5 mV with symptoms
- New Left Bundle Branch Block
- Sustained Ventricular Tachycardia
- Criteria: Intermediate risk (absence of above high risk features)
- Age over 65 years
- No high probability ACS physical findings
- Equivocal elevation of Serum Cardiac Markers
- Known vascular disease
- Prior Myocardial Infarction
- Known Coronary Artery Disease
- Prior Cerebrovascular Accident
- Rest Angina
- Lasted >20 minutes but now resolved
- Lasted <20 minutes and relieved with Nitroglycerin
- Nocturnal Angina
- Electrocardiogram
- Angina with T-wave inversion >0.2 mV
- Pathologic Q Waves
- Rest ST depression <1 mm in multiple leads
- Criteria: Low risk (absence of above high/moderate risk features)
- New onset class 1-3 Angina in last 2 weeks <20 minutes
- Normal cardiovascular exam
- Normal Electrocardiogram
- No increase in Serum Cardiac Markers
- Interpretation (see Non-diagnostic EKG Protocol)
- High Risk by above probability of adverse event
- See Immediate MI Management
- See Myocardial Ischemia Protocol
- Intermediate risk by above probability of adverse event
- See Non-diagnostic Electrocardiogram Protocol
- Requires risk stratification before discharge
- Serial Troponin I for six hours
- Exercise Stress Test
- Low risk by above probability of adverse event
- See Non-diagnostic Electrocardiogram Protocol
- May discharge to home from emergency department
- Outpatient stress test within 72 hours
- Discuss coronary warning signs
- Close interval follow-up
- References
- Braunwald (1994) AHCPR Publication 94-0602