Unstable Angina

Introduction

Stable Angina

Acute MI w/ ST-segment elevation

~300,000
> men
Unstable Angina
Non-ST-segment elevation MI
~1.3 M
~ women
 Definition
UA is defined as angina pectoris or equivalent ischemic
discomfort with at least one of three features:

occurs at rest usually lasting >10 min

1

severe and of new onset

2 within the prior 46 weeks

occurs with a crescendo pattern

3 distinctly more severe, prolonged, or frequent than previously
 Pathophysiology
Unstable
Plaque angina
Athero- rupture/
Fatty Fibrous sclerotic fissure &
Normal streak plaque plaque thrombosis MI

Ischemic
stroke/TIA

Critical leg
ischemia
Clinically silent
Stable angina
Intermittent claudication Cardiovascular
death

Increasing age

Atherothrombosis : a Generalized and Progressive Process

 4 pathophysiologic processes
contributing to unstable angina
plaque rupture or erosion
1.
dynamic obstruction
2. coronary spasm

progressive mechanical obstruction

3.
secondary UA related to increased
4. demand or reduced supply
 Clinical Presentation
chest pain
onset - patient at rest/awakened from sleep
substernal region/epigastrium
radiates to the neck, left shoulder, & left arm
discomfort is usually severe enough to be considered
painful
sublingual nitroglycerin
transient relief/none
possible accompanying symptoms
diaphoresis
dyspnea
nausea
lightheadedness
Condition Duration Quality Location Associated
Features
Angina 3-9 mins Pressure, Retrosternal, often w/ Precipitated by exertion,
tightness, radiation to or isolated exposure to cold,
squeezing, discomfort in neck, psychologic stress
heaviness, jaw, shoulders or S4 gallop or mitral
burning arms frequently on regurgitation murmur
left during pain
Unstable 10-20 mins Similar to angina Similar to angina Similar to angina, but
but often more occurs w/ low levels of
angina
severe exertion or even at rest
 Physical Examination
tachycardia
hypertension
transient S3 or S4
transient or increased murmur
of mitral regurgitation
papillary muscle ischemia
Thank You!