Cardiovascular Medicine Book

Electrocardiogram

Myocardial Infarction

Symptoms

Circulatory Disorders

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Unstable Angina

Aka: Unstable Angina
  1. See Also
    1. Chest Pain
    2. Angina
    3. Angina Diagnosis
  2. Symptoms
    1. Ongoing Angina-type pain
      1. Despite decreasing level of exertion
      2. With increasing severity or frequency
      3. Rest pain in the last week
      4. Class 3 or 4 Chest Pain
      5. Pain following Myocardial Infarction (over 24 hours)
    2. Varying patterns of radiating pain
    3. History non-q wave Myocardial Infarction
    4. Atypical presentations are common over age 65 (50%)
      1. Atypical Chest Pain or arm, epigastric or Neck Pain
      2. Shortness of Breath
      3. Diaphoresis
      4. Nausea
      5. Canto (2002) Am J Cardiol 90:248-53
  3. Signs
    1. Dyskinetic apical impulse
    2. New S3 Gallop rhythm
    3. New S4 Gallop rhythm
    4. New or worsening Mitral Regurgitation murmur
    5. Secondary Congestive Heart Failure
      1. Rales
      2. Hypotension
  4. Differential Diagnosis
    1. Acute Myocardial Infarction
    2. Aortic Dissection
    3. Pericarditis
    4. Cardiac Tamponade
    5. Pneumothorax
    6. Pulmonary Embolus
    7. Peptic Ulcer Disease
    8. Cholecystitis or Cholelithiasis
    9. Esophageal Spasm
    10. Cervical Disc Disease
  5. Electrocardiogram
    1. EKG in Myocardial Ischemia
  6. Management
    1. See Ischemic Chest Pain Management
  7. Indications for angiography in Unstable Angina
    1. Failure to stabilize with adequate medical therapy
    2. Recurrent or persistent pain or ischemia
    3. Previous revascularization procedure
    4. Multiple admissions for undiagnosed Chest Pain
    5. High-risk findings on clinical assessment
      1. Congestive Heart Failure
      2. Left Ventricular Dysfunction
      3. Mitral Regurgitation (new or worsening)
      4. Malignant ventricular arrhythmia
      5. Positive Exercise Stress Test or Stress Imaging
  8. Prognosis
    1. See Unstable Angina Prognosis

Angina, Unstable (C0002965)

Definition (NCI) Angina pectoris (or equivalent type of ischemic discomfort) with any 1 of the 3 following features: a) Angina occurring at rest and prolonged, usually greater than 20 minutes; b) New onset angina of at least Canadian Cardiovascular Society Grading Scale (or CCS classification system) classification severity III or greater; c) Recent acceleration in angina accentuated by an increase in severity of at least 1 CCS class to at least CCS class III. The biomarkers of necrosis are below the threshold of myocardial infarction. (NIH Roadmap Cardiovascular Data Standards Working Group)
Definition (MSH) Precordial pain at rest, which may precede a MYOCARDIAL INFARCTION.
Definition (NCI) Angina pectoris (or equivalent type of ischemic discomfort) which has recently changed in frequency, duration, intensity, or occurs at rest.
Concepts Disease or Syndrome (T047)
MSH D000789
ICD9 411.1
ICD10 I20.0
SnomedCT 233818002, 194816008, 194819001, 155314002, 155313008, 194817004, 155308009, 194814006, 233820004, 64333001, 4557003, 59021001, 25106000
English Intermediate ischemic heart syndrome, Angina pectoris, unstable, Preinfarction angina, Angina, Preinfarction, Anginas, Preinfarction, Anginas, Unstable, Preinfarction Anginas, Unstable Angina, Unstable Anginas, UNSTABLE ANGINA PECTORIS, ANGINA UNSTABLE, CRESCENDO ANGINA, Preinfarction Angina, Angina at Rest, Angina pectoris, crescendo, Unstable Angina Pectoris, unstable angina pectoris, crescendo angina pectoris, unstable angina pectoris (diagnosis), crescendo angina pectoris (diagnosis), Angina at rest (disorder), Unstable angina (disorder), Worsening angina (disorder), (Angina: [crescendo] or [unstable] or [at rest]) or (preinfarction syndrome) or (impending infarction) (disorder), unstable angina, crescendo angina, Angina pectoris unstable, Angina unstable, Angina worsened, Preinfarction angina (disorder), Intermed coronary synd, Angina, Unstable, Angina, Unstable [Disease/Finding], Angina;unstable, Infarction;impending, angina at rest, intermediate coronary syndrome, rest angina, angina unstable, pre-infarction syndrome, preinfarction angina, Unstable Angina Pectori, Angina Pectori, Unstable, Angina Pectoris, Unstable, Intermediate coronary syndrome, Anginal chest pain at rest, Crescendo angina, Impending infarction, Unstable angina, Angina at rest, Worsening angina, Impending infarction (disorder), coronary; syndrome, crescendo; angina, intermediate coronary; syndrome, preinfarctional; angina, rest; angina, syndrome; coronary, syndrome; intermediate coronary, angina pectoris; at rest, angina pectoris; crescendo, angina pectoris; unstable, unstable; angina, (Angina: [crescendo] or [unstable] or [at rest]) or (preinfarction syndrome) or (impending infarction), impending infarction
French ANGOR INSTABLE, Angor aggravé, Angor crescendo, Syndrome coronarien intermédiaire, Angor au repos, État de mal angineux, Angor instable, Angor de repos, Angor préinfarctus
Portuguese ANGINA INSTAVEL, Angina instável, Pseudo-angina instável, Angina agravada, Angina de repouso, Síndrome coronária intermédia, Angina em crescendo, Angina de peito instável, Angina em Repouso, Angina Instável, Angina Pré-Infarto
Spanish ANGINA INESTABLE, Angina de pecho inestable, Empeoramiento de la angina, Angina in crescendo, Síndrome coronario intermedio, Angina de reposo, Preinfarction syndrome, Angina at rest, Pre-infarction syndrome, Worsening angina, Impending infarction, (Angina: [crescendo] or [unstable] or [at rest]) or (preinfarction syndrome) or (impending infarction), Crescendo angina, Unstable angina, angina preinfarto, angina preinfarto (trastorno), angina de pecho de reposo (trastorno), angina de pecho de reposo, angina inestable, infarto inminente (trastorno), infarto inminente, síndrome coronario intermedio, Angina inestable, Angina de Reposo, Angina Inestable, Angina Preinfarto
Dutch angina verergerd, angina bij rust, angina pectoris instabiel, onstabiele angina, tussentijds coronair syndroom, crescendo-angina, angina pectoris; crescendo, angina pectoris; in rust, angina pectoris; instabiel, coronair; syndroom, crescendo; angina, instabiel; angina, intermediair coronair; syndroom, pre-infarct; angina, rust; angina, syndroom; coronair, syndroom; intermediair coronair, Instabiele angina pectoris, angina instabiel, Angina pectoris in rust, Angina pectoris, onstabiele, Onstabiele angina pectoris, Angina, preïnfarct-
German Angina pectoris in Ruhelage, Angina verschlechtert, Crescendo-Angina, intermediaeres Koronarsyndrom, instabile Angina, ANGINA PECTORIS INSTABIL, Angina pectoris instabil, Angina pectoris, instabile, Instabile Angina pectoris, Angina, Ruhe-, Ruheangina, Angina, Präinfarkt-, Präinfarktangina
Italian Angina pectoris instabile, Sindrome coronarica intermedia, Angina ingravescente, Angina in crescendo, Angina a riposo, Angina pre-infartuale, Angina instabile
Japanese 安静狭心症, 中間冠動脈症候群, 漸増型狭心症, アンギナ増悪, ｱﾝｷﾞﾅｿﾞｳｱｸ, ﾌｱﾝﾃｲｷｮｳｼﾝｼｮｳ, ﾁｭｳｶﾝｶﾝﾄﾞｳﾐｬｸｼｮｳｺｳｸﾞﾝ, ｱﾝｾｲｷｮｳｼﾝｼｮｳ, 狭心症-安静時, 心筋梗塞前症候群, 心筋梗塞先行狭心痛, 不安定狭心症, 狭心痛-心筋梗塞先行, ｾﾞﾝｿﾞｳｶﾞﾀｷｮｳｼﾝｼｮｳ, 安静時狭心症, 狭心症-不安定
Swedish Angina, instabil
Finnish Epävakaa rasitusrintakipu
Russian PREDINFARKTNOE SOSTOIANIE, STENOKARDIIA NESTABIL'NAIA, MIOKARDIAL'NYI PREDINFARKTNYI SINDROM, STENOKARDIIA PREDINFARKTNAIA, МИОКАРДИАЛЬНЫЙ ПРЕДИНФАРКТНЫЙ СИНДРОМ, ПРЕДИНФАРКТНОЕ СОСТОЯНИЕ, СТЕНОКАРДИЯ НЕСТАБИЛЬНАЯ, СТЕНОКАРДИЯ ПРЕДИНФАРКТНАЯ
Czech Nestabilní angina pectoris, Zhoršená angina pectoris, Crescendo angina, Intermediární koronární syndrom, Klidová angina pectoris, NAP, angina pectoris nestabilní, nestabilní angina pectoris
Korean 불안정성 협심증
Croatian ANGINA, NESTABILNA
Polish Dławica niestabilna, Dusznica bolesna niestabilna, Dławica piersiowa niestabilna
Hungarian Intermediaer coronaria syndroma, Instabil angina, Nyugalmi angina, Crescendo angina, Angina rosszabbodott, Angina pectoris, instabil
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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