Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.

1. Unstable Angina
BRAJESH LAHRI
FINAL PROFESSIONAL MBBS
ALL INDIA INSTITUTE OF MEDICAL
SCIENCES(AIIMS),BHOPAL

2. 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

3. 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)

4. 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

5. Flowchart depicting
pathogenesis of Acute Coronary
artery disease i.e. Unstable
Angina

6. Risk Factors
 Hypertension
 Smoking
 Hereditary factors
 Diabetes
 Dyslipidemia
 Obesity

7. 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

8. Diagnostic Evaluation
Clinical History
Electrocardiogr
am (ECG)
Cardiac
Markers
Stress Testing

9. Diagnostic Evaluation

10. Management
Management
Medical
Management
Surgical
Management

11. 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)

12. 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.