Unstable Angina

Overview Of Unstable Angina

Unstable angina is a condition in which your heart doesn’t get enough blood flow and oxygen. It may lead to a heart attack.

Angina is a type of chest discomfort caused by poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).

Commonly Associated With

Accelerating angina; New-onset angina; Angina – unstable; Progressive angina; CAD – unstable angina; Coronary artery disease – unstable angina; Heart disease – unstable angina; Chest pain – unstable angina

Causes Of Unstable Angina

Coronary artery disease due to atherosclerosis is the most common cause of unstable angina. Atherosclerosis is the buildup of fatty material, called plaque, along the walls of the arteries. This causes arteries to become narrowed and less flexible. The narrowing can reduce blood flow to the heart, causing chest pain. People with unstable angina are at higher risk of having a heart attack.

Rare causes of angina are:

• Abnormal function of tiny branch arteries without narrowing of larger arteries (called microvascular dysfunction or Syndrome X)
• Coronary artery spasm

Risk factors for coronary artery disease include:

• Diabetes
• Family history of early coronary heart disease (a close relative such as a sibling or parent had heart disease before age 55 in a man or before age 65 in a woman)
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Male sex
• Sedentary lifestyle (not getting enough exercise)
• Obesity
• Older age
• Smoking

Symptoms Of Unstable Angina

Symptoms of angina may include:

• Chest pain that you may also feel in the shoulder, arm, jaw, neck, back, or other area
• Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching
• Discomfort that occurs at rest and does not easily go away when you take medicine
• Shortness of breath
• Sweating
• With stable angina, chest pain or other symptoms only occur with a certain amount of activity or stress. The pain does not occur more often or get worse over time.

Unstable angina is chest pain that is sudden and often gets worse over a short period of time. You may be developing unstable angina if the chest pain:

• Starts to feel different, is more severe, comes more often, or occurs with less activity or while you are at rest
• Lasts longer than 15 to 20 minutes
• Occurs without cause (for example, while you are asleep or sitting quietly)
• Does not respond well to a medicine called nitroglycerin (especially if this medicine worked to relieve chest pain in the past)
• Occurs with a drop in blood pressure or shortness of breath
• Unstable angina is a warning sign that a heart attack may happen soon and needs to be treated right away. See your health care provider if you have any type of chest pain.

Exams & Tests

The provider will do a physical exam and check your blood pressure. The provider may hear abnormal sounds, such as a heart murmur or irregular heartbeat, when listening to your chest with a stethoscope.

Tests for angina include:

• Blood tests to show if you have heart tissue damage or are at a high risk for heart attack, including troponin I and T-00745, creatine phosphokinase (CPK), and myoglobin.
• ECG.
• Echocardiography.
• Stress tests, such as exercise tolerance test (stress test or treadmill test), nuclear stress test, or stress echocardiogram.
• Coronary angiography. This test involves taking pictures of the heart arteries using x-rays and dye. It is the most direct test to diagnose heart artery narrowing and find clots.

Treatment Of Unstable Angina

Unstable angina is a warning sign of an imminent heart attack. It needs to be treated immediately.

You need to check with the hospital for more tests to prevent complications.

Blood thinners (antiplatelet drugs) are used for treatment and prevention. Other medicines to consider include aspirin and clopidogrel or something similar (ticagrelor, prasugrel).

These medicines may reduce the chance of a heart attack or the severity of a heart attack if it occurs.

During an unstable angina event:

• You may be given a blood thinner (like heparin) and nitroglycerin (under the tongue or through an IV).
• Other treatments include medication to control blood pressure, abnormal heart rhythms, anxiety, and cholesterol.
• A procedure called angioplasty and stenting to open a blocked artery.

Heart bypass surgery may be necessary for some people.

Having this surgery depends on:

• Which arteries are blocked
• Number of affected arteries
• Parts of the coronary arteries narrowed
• Severity the narrowings