Unstable Angina Questions & Answers

Updated: May 07, 2019
  • Author: Walter Tan, MD, MS; Chief Editor: Eric H Yang, MD  more...
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Questions & Answers

Overview

What is unstable angina?

Which physical findings suggest unstable angina?

What are the symptoms of unstable angina?

Which lab studies are included in the evaluation of unstable angina?

Which tests may be considered in the evaluation of unstable angina?

Which imaging studies are performed in the evaluation of unstable angina?

What is the focus of treatment for unstable angina?

What is the initial treatment for unstable angina?

Which medications are used in the treatment of unstable angina?

What are the surgical options for the treatment of unstable angina?

What is unstable angina?

How is unstable angina distinct from stable angina?

Which factors are involved in the pathophysiology of unstable angina?

What is the pathophysiology of the myocardial ischemia of unstable angina?

What causes myocardial oxygen demand in unstable angina?

What causes a decreased oxygen supply in unstable angina?

Which causes of the supply-demand mismatch in the pathophysiology of unstable angina may be reversible?

What is the role of plaque disruption in the pathophysiology of unstable angina?

What is the role of vasoconstriction and thrombosis in the pathophysiology of unstable angina?

What is the role of genetics in the pathophysiology of unstable angina?

What is the incidence of unstable angina in the US?

What are the patient characteristics for unstable angina in the US?

What is the patient characteristics for unstable angina globally?

How does the mean age for presentation of unstable angina vary among patient groups?

How does the incidence of unstable angina vary by sex?

What are the racial predilections of unstable angina?

What is the prognosis of unstable angina?

What are 30 day clinical outcomes for unstable angina?

What are the 12-month event rates for unstable angina?

What are the prognostic indicators of poor outcome in unstable angina?

How does epicardial adipose tissue thickness (EAT) affect the prognosis of unstable angina?

What is included in patient education about unstable angina?

Presentation

What is the focus of clinical history for unstable angina?

How does the presentation of unstable angina differ from stable angina?

What should be included in the history of chest pain in suspected unstable angina?

How is chest pain characterized in unstable angina?

Which conditions should be considered during the physical exam of unstable angina?

What is the presentation of increased autonomic activity in patients with unstable angina?

What are the signs and symptoms of myocardial jeopardy in unstable angina?

Which physical findings indicate peripheral arterial occlusive or prior stroke in unstable angina?

What are signs suggestive of congestive heart failure (CHF) in unstable angina?

Why is the classification of unstable angina challenging?

What is the Braunwald classification for unstable angina?

How is unstable angina categorized in the Braunwald classification system?

How is the intensity of antianginal therapy classified for unstable angina?

What is the Canadian Cardiovascular Society Grading System for unstable angina?

Which factors indicate a high risk of acute coronary syndrome (ACS) in unstable angina?

Which factors indicate an intermediate risk of acute coronary syndrome (ACS) in unstable angina?

Which factors indicate a low risk for acute coronary syndrome (ACS) in unstable angina?

What is the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for unstable angina/non-ST elevation MI (UA/NSTEMI)?

DDX

When is serial testing indicated for unstable angina?

Which condition may present with unstable angina?

Which conditions should be considered in the differential diagnoses for unstable angina?

How is variant (Prinzmetal) angina characterized?

How can the differential diagnoses for unstable angina be categorized?

What are the differential diagnoses for Unstable Angina?

Workup

What is included in the initial workup for unstable angina?

Which lab studies should be performed within the first 24 hours of suspected unstable angina?

What is the role of cardiac biomarkers in the diagnosis of unstable angina?

What is the role of chest radiography in the workup of unstable angina?

What is the prognosis of undiagnosed unstable angina?

How can missed diagnosis of unstable angina be prevented?

What is the role of the CBC count in the workup of unstable angina?

What is the role of potassium and magnesium level monitoring in patients with unstable angina?

What is the role of creatinine measurement in the workup of unstable angina?

What is the role of myeloperoxidase measurement in the workup of unstable angina?

Which cardiac markers are useful in the evaluation of unstable angina?

What is the current standard of care for use of creatine kinase, CK-MB, and troponin cardiac biomarkers in the evaluation of unstable angina?

What do troponin levels indicate in the evaluation of unstable angina?

What should be considered when using troponin levels in the diagnosis of unstable angina?

What is the role of brain (B-type) natriuretic peptide (BNP) in the workup of unstable angina?

Which combination of biomarkers may be useful in the workup of unstable angina?

What is the first line of assessment in suspected unstable angina?

How are electrocardiographic (ECG) findings used in the management of unstable angina?

What is the significance of primary T wave changes on electrocardiography for unstable angina?

What is the Wellens syndrome in unstable angina?

What are the benefits of echocardiography in the workup of unstable angina?

What is the sensitivity of single-photon emission computed tomography (SPECT) for unstable angina?

What is the role of MRI in the workup of unstable angina?

What is the role of myocardial perfusion imaging in the workup of unstable angina?

What is the role of exercise testing in the workup of unstable angina?

What are the benefits of predischarge exercise testing for patients with unstable angina?

What are the predictive values of stress tests in the workup of unstable angina?

What is the efficacy of early stress testing for triage in unstable angina?

Treatment

What is the focus of treatment for unstable angina?

What is included in the initial inpatient treatment of unstable angina?

What are the treatment strategies for unstable angina?

How should primary causes of ischemia be managed in unstable angina?

What is the proper level of care and expertise for the treatment of unstable angina?

When is admission to an ICU indicated for the treatment of unstable angina?

When is admission to an intermediate care unit indicated for the treatment of unstable angina?

When is admission to an observation unit indicated for the treatment of unstable angina?

What is the role of medications in the treatment of unstable angina?

Which dietary modifications are used in the treatment of unstable angina?

Which medications are used in the initial management of unstable angina?

How is aspirin administered for the treatment of unstable angina?

What is the role of beta blockers in the treatment of unstable angina?

What is the role of clopidogrel in the treatment of unstable angina?

What are the benefits of clopidogrel for the treatment of unstable angina?

What risks are associated with the use of clopidogrel for the treatment of unstable angina?

What are strategies to overcome the variability in the metabolism and efficacy of clopidogrel for the treatment of unstable angina?

What advantages of clopidogrel over prasugrel for the treatment of unstable angina?

What are the benefits and risks of prasugrel for the treatment of unstable angina?

What are contraindications for prasugrel for the treatment of unstable angina?

What is the efficacy of prasugrel for the treatment of unstable angina?

What is the role of ticagrelor in the treatment of unstable angina?

What is the role of glycoprotein IIb/IIIa antagonists (abciximab) (eptifibatide) (tirofiban) in the treatment of unstable angina?

Which glycoprotein IIb/IIIa antagonists have been shown to be beneficial for the treatment of unstable angina in high risk patients?

What is the role of low-molecular-weight heparin (LMWH) in the treatment of unstable angina?

What are is the efficacy of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of unstable angina?

What are safe alternatives to low-molecular-weight heparin (LMWH) for the treatment of unstable angina?

Which direct thrombin inhibitors are alternatives to heparin for the treatment of unstable angina?

What is the efficacy of direct thrombin inhibitors for the treatment unstable angina?

What is the role of lepirudin in the treatment of unstable angina?

What is the role of bivalirudin in the treatment of unstable angina?

When are direct thrombin inhibitors used in the treatment of unstable angina?

What is the role of nitrates in the treatment of unstable angina?

Which medications are used in the ongoing management of unstable angina?

What is the role of statin therapy in the treatment of unstable angina?

What is the efficacy of statin therapy for the treatment of unstable angina?

What may improve patient adherence to statin therapy for unstable angina?

What are FDA safety alerts regarding the use of statin therapy for the treatment of unstable angina?

What is the role of ACE inhibitors in the treatment of unstable angina?

Which medications may be beneficial for the treatment of unstable angina?

What are the indications for immediate cardiac catheterization in patients with unstable angina?

What is the prevalence of significant unstable angina?

What is the efficacy of routine catheterization for the treatment of unstable angina?

What is the efficacy of early invasive therapy for the treatment of unstable angina?

What are reported benefits of early invasive strategy in the treatment of unstable angina?

How does the timing of cardiac catheterization affect outcomes for unstable angina?

What is the role of revascularization in the treatment of unstable angina?

What are the benefits of revascularization for the treatment of unstable angina?

What is the cost-to-benefit ratio of an initial invasive approach for the treatment of unstable angina?

What is the role of coronary artery bypass grafting (CABG) in the treatment of unstable angina?

What is the included in patient monitoring following revascularization for unstable angina?

What are the goals of secondary prevention in patients with unstable angina?

What are the goals of smoking cessation in patients with unstable angina?

What is the target lipid levels in patients with unstable angina?

What are the blood pressure targets in patients with unstable angina?

How is diabetes mellitus managed in patients with unstable angina?

What is the target BMI in patients with unstable angina?

What is included in psychosocial management of patients with unstable angina?

Which activity modifications are used in the management of unstable angina?

Which specialist consultations are beneficial in the treatment of unstable angina?

Guidelines

Which organizations have issued treatment guidelines for unstable angina?

What were key changes to the 2014 AHA/ACC revised treatment guidelines for non–ST-elevation acute coronary syndromes (NSTE-ACS)?

What are the AHA/ACC guidelines class I recommendations for the evaluation of acute coronary syndromes (ACSs)?

What are the AHA/ACC class IIa recommendations for the evaluation of suspected acute coronary syndromes (ACSs)?

What are ESC class I recommendations for the evaluation of acute coronary syndromes (ACSs)?

What is the preferred management strategy for the treatment of acute coronary syndromes (ACSs)?

What are the AHA/ACC recommendations for oxygen use in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for nitrate use in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for analgesic therapy in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for beta-adrenergic blockers in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for calcium channel blockers (CCBs) in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for cholesterol management in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for ACE inhibitors (ACEIs) in initial hospital care of unstable angina?

What are the AHA/ACC recommendations for aspirin use in initial antiplatelet/anticoagulation therapy of unstable angina?

What are options for anticoagulation for the treatment of unstable angina?

What are the benefits of dual antiplatelet therapy (DAPT) for the treatment of coronary artery disease (CAD)?

What are the AHA/ACC class I recommendations for dual antiplatelet therapy (DAPT) for non–ST-elevation acute coronary syndromes (NSTE-ACS)?

What are the AHA/ACC class IIa recommendations for dual antiplatelet therapy (DAPT) for non–ST-elevation acute coronary syndromes (NSTE-ACS)?

What are the AHA/ACC class IIb recommendations for dual antiplatelet therapy (DAPT) for non–ST-elevation acute coronary syndromes (NSTE-ACS)?

According to AHA/ACC guidelines, when is prasugrel not recommended?

What are the AHA/ACC recommendations for hospital discharge and follow-up of patients with non–ST-elevation acute coronary syndromes (NSTE-ACS)?

What are the AHA/ACC recommendations for the management of non–ST-elevation acute coronary syndromes (NSTE-ACS) in patients with diabetes?

What are the ESC class I recommendations for the treatment of diabetes in patients with non–ST-elevation acute coronary syndromes (NSTE-ACS)?

What are the ESC class IIa recommendations for the treatment of diabetes in patients with non–ST-elevation acute coronary syndromes (NSTE-ACS)?

Medications

Which medications have been shown to reduce short- or long-term adverse events in patients with unstable angina?

Which medications in the drug class Thrombin inhibitors are used in the treatment of Unstable Angina?

Which medications in the drug class ACE Inhibitors are used in the treatment of Unstable Angina?

Which medications in the drug class Low Molecular Weight Heparins are used in the treatment of Unstable Angina?

Which medications in the drug class Anticoagulant are used in the treatment of Unstable Angina?

Which medications in the drug class Beta-Blockers, Nonselective; Antidysrhythmics, II are used in the treatment of Unstable Angina?

Which medications in the drug class Beta-Blockers, Nonselective are used in the treatment of Unstable Angina?

Which medications in the drug class Beta-Blockers, Beta-1 Selective; Antidysrhythmics, II are used in the treatment of Unstable Angina?

Which medications in the drug class Beta-Blockers, Beta-1 Selective are used in the treatment of Unstable Angina?

Which medications in the drug class Antiplatelet Agent, Cardiovascular are used in the treatment of Unstable Angina?

Which medications in the drug class PCSK9 Inhibitors are used in the treatment of Unstable Angina?

Which medications in the drug class Lipid-Lowering Agents, Statins are used in the treatment of Unstable Angina?

Which medications in the drug class Antiplatelet agents are used in the treatment of Unstable Angina?

Which medications in the drug class Nitrates, Angina are used in the treatment of Unstable Angina?