Unstable angina

Internal Medicine

NSTEMI & UNSTABLE ANGINA

Investigations and Treatment
High risk patient who are likely to progress to MI require urgent coronary angiography in less than 72 Hours

Who are high risk patient ?

• Increased Troponin
• Dynamic ST or T wave changes
• Previous MI
• PCI within last 6 months
• Previous CABG

Medical Treatment Unstable Angina & NSTEMI

• O2 ⇒
• Morphine and anti emetic ⇒
• Aspirin ⇒
• Clopidrogrel (Plavix )- anti platelet agent OR : Dual AP therapy with Aspirin & Prasugrel or ticagrelor ⇒
• Enoxaprin- low molecular heparin ⇒
• Beta blocker ⇒
• (Bisoprolol) ⇒
• ACE-Inhibitors ⇒
• Nitrates ⇒
• Statins ⇒

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Thera

Unstable angina may present by one of the following:

• ~ Angina at rest
• ~ Crescendo angina (increased frequency and severity)
• ~ Angina of recent onset (within 4-6 weeks)

It may be due to:

• Non-occlusive coronary thrombus on top of atheroma. • Coronary artery spasm (Prinzmetal’s angina).

Unstable angina (UA) is considered to be present in patients with: ischemic symptoms suggestive of an ACS without elevation in biomarkers with or without ECG changes indicative of ischemia.

Diagnosis:

• ECG: shows changes in 30-50%.
• Cardiac enzymes: are not elevated distinguished from acute MI.
• Coronary angiography.