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Unstable Angina

CardiologyPatients with Ischemic heart disease fall into two categories
1.Stable angina due to chronic Coronary Artery disease
2.Acute Coronary Artery Syndromes (ACS)

The latter group are compased of
a)Patients with acute myocardial infarction with ST-segment elevation
b)Patients with Unstable Angina and non ST segment elevation.

Unstable angina is defined as Angina or equivalant ischemic discomfort with atleast one of the three features -
1.It occurs at rest (usually lasting > 10 mins)
2.It is severe and of new onset
3.It occurs with a cresendo pattern(more severe,prolonged or frequentthan the previous attack)
Clinical presentation :


  • Chest pain - typically substernal region or epigastric discomfort that frequently radiates to neck,left shoulder or left arm.
  • Dyspnoea
  • Diaphoresis
  • Pale cool skin
  • Tachycardia(Increased heart rate)
  • Audible third or fourth heart sounds
  • Basilar rales
  • Sometimes hypotension


Electrocardiogram :
ST segment elevation or transient depression are seen.The presence of new ST segment deviation is an important predictor of adverse outcome.

Cardiac Biochemical markers :

  • CK-MB
  • Troponin (more specific)

Factors which corelate with increased moratality and recurrent cardiac events :

  • C-reactive protien
  • B-type natriuretic peptite
  • CD-40

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