Unstable Angina
Unstable angina - Is it time for a requiem? - Eugene Braunwald MD, 2013
image by: Sakshi Singh
HWN Suggests
Does Observation for ACS Make Sense? Part 2: Identifying ACS
What is unstable angina?
Is it even real? Probably not. Look at it this way: the person who created the first guidelines for the diagnosis and treatment of unstable angina (UA) no longer believes it to be a real entity. The definition was created at a time when we were still using CK-MB as evidence of myocardial necrosis. As mentioned earlier, troponin is far more sensitive and specific than CK-MB. By 2000, AHA guidelines estimated that more than one-third of patients previously thought to have UA would be reclassified as NSTEMI, given they would have had a positive troponin.
Since then, troponins have become even more sensitive with a lower cut point for…
Resources
Unstable Angina Is It Time for a Requiem?
A requiem is a choral musical work that is performed at the funeral of a great personage or at the close of an important era. Has not the time arrived to prepare a requiem for UA?
Angina Can Be Stable or Unstable
Stable angina can become unstable. For instance, if you usually have chest discomfort every time you walk two blocks, that would be considered stable angina. However, if that pattern of chest discomfort changes over the course of a short period of time, then the angina has become unstable
Critical review of unstable angina and non-ST elevation myocardial infarction
Within the coronary vasculature the progression of a stable atherosclerotic plaque into a vulnerable and ultimately unstable lesion leads to a cascade of events culminating in the clinical presentation of unstable angina or acute myocardial infarction.
Is That Chest Pain Unstable Angina or Acute Coronary Syndrome?
One of the more expensive questions any emergency physician can ask is: Does the patient complaining of chest pain have unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI)?
Does Observation for ACS Make Sense? Part 2: Identifying ACS
What is unstable angina? Is it even real? Probably not. Look at it this way: the person who created the first guidelines for the diagnosis and treatment of unstable angina (UA) no longer believes it to be a real entity. The definition was created at a time when we were still using CK-MB as evidence of myocardial necrosis. As mentioned earlier, troponin is far more sensitive and specific than CK-MB. By 2000, AHA guidelines estimated that more than one-third of patients previously thought to have UA would be reclassified as NSTEMI, given they would have had a positive troponin.
StatPearls
Unstable angina falls along a spectrum under the umbrella term acute coronary syndrome. This public health issue that daily affects a large portion of the population remains the leading cause of death worldwide. Distinguishing between this and other causes of chest pain that include stable angina is important regarding the treatment and disposition of the patient.
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