Unstable Angina

BRAJESH LAHRI

FINAL PROFESSIONAL MBBS

ALL INDIA INSTITUTE OF MEDICAL

SCIENCES(AIIMS),BHOPAL

Introduction

A form of Ischemic Heart Disease (IHD)

IHD can be divided into two groups

Unstable Angina (UA) is a part of Acute Coronary Syndrome (ACS)

Chronic

Coronary

Artery

Disease

Acute

Coronary

Syndromes

Definition

Unstable Angina (UA) can be defined as angina pectoris or equivalent

ischemic discomfort with presence of any one of the following features :

It occurs at rest or with minimal exertion and lasts more than 10 minutes

It is severe in nature and acute in onset

Attacks are more severe ,prolonged and frequent than previous attacks

(Also known as Crescendo Pattern)

Etiopathogenesis

Ischemic Heart Disease Key Problem Decreased Blood Supply to Myocardium (i.e.

Myocardial ischemia)

Decreased Myocardial

Oxygen Supply (Ex:

Partial/Complete Occlusion

of Blood vessel lumen,

Coronary artery spasm)

Increased Myocardial

Oxygen Demand (Ex: Physical

activity , Emotional

Excitement)

Myocardial

Ischemia

Angina

Flowchart depicting

pathogenesis of Acute Coronary

artery disease i.e. Unstable

Angina

Risk Factors

Hypertension

Smoking

Hereditary factors

Diabetes

Dyslipidemia

Obesity

Clinical Manifestations

CHEST PAIN( May radiate to SHOULDER, ARM,JAW,NECK,BACK)

CHEST DISCOMFORT THAT FEELS LIKE TIGHTNESS, SQUEEZING, CRUSHING, BURNING)

SHORTNESS OF BREATH

SWEATING

Diagnostic Evaluation

Clinical HistoryElectrocardiogr

am (ECG)Cardiac Markers

Stress Testing

Diagnostic Evaluation

Management

Management

Medical

Management

Surgical

Management

MEDICAL MANAGEMENT

Blood thinners (antiplatelet drugs) are used to treat and prevent unstable angina.

These medicines may be able to reduce the chance of a heart attack or the

severity of a heart attack that occurs.

During an unstable angina event:

Patient is given heparin (or another blood thinner) and nitroglycerin (under the

tongue or through an IV)

Other treatments may include medicines to control blood pressure,

anxiety, abnormal heart rhythms, and cholesterol (such as a statin drug)

SURGICAL MANAGEMENT

Early coronary angiography and revascularization are the main aims of surgical

management of Unstable angina.

Either Per Cutaneous angioplasty (PCA) or Coronary artery bypass graft (CABG) is

the treatment of choice for high risk patient with unstable angina.