This document outlines the progression of coronary artery disease from stable angina to acute coronary syndrome. Stable angina involves exertional chest pain but no symptoms at rest, while unstable angina includes symptoms at rest or that are worsening. Acute coronary syndrome encompasses both non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI), which are types of heart attack involving changes on electrocardiograms and elevated troponin levels. The therapies described aim to reduce ischemia and inflammation and include medications like aspirin, beta blockers, and statins.

1. DISEASE PROGRESS
STABLE
ANGINA
C A D S i m o n M a r k D a l e y ( 2 0 1 9 )
; a 'spectrum' of syndromes.oronary rtery isease
UNSTABLE
ANGINA
NSTEMI STEMI
ACUTE CORONARY SYNDROME (ACS)
ST-segment Elevation
Myocardial Infarction
Non ST-segment Elevation
Myocardial Infarction
MI (HEART ATTACK)
ANGINA
THERAPY;
ACS
THERAPY;
Aspirin
Ticagrelor (or equivalent)
Beta Blocker (or CCB)
ACE inhibitor (or ARB)
Statin
Fondaparinux (pre angio)
Coronary angiogram
Transthoracic echocardiogram
Aspirin
Beta Blocker
Statin
+/- CCB / Nitrate / Ranolazine
Coronary angiogram
if symptoms continue on 2
anti-anginal agents
Exertional ischaemic
symptoms
troponin -ve
ECG likely to be normal,
although may show
ischaemia - particularly
during pain
No symptoms at rest
Established STABLE ANGINA,
now w/ symptoms at rest OR
crescendo in nature
Ischaemic
symptoms
Ischaemic
symptoms
troponin -ve
ECG may show
ischaemia
(less likely)
troponin +ve troponin +ve
ECG may show
ischaemia
(more likely)
ECG showing ST
segment elevation -
likely w/ reciprical
ischaemia