Unstable angina

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Coronary artery balloon angioplasty - series

Accelerating angina; New-onset angina; Angina - unstable; Progressive angina

Typical anginal pain usually originates in the chest and may radiate to the shoulder, arm, jaw, neck, back or other areas. The pain is often described as tightness, squeezing, crushing, burning, choking or aching. Unstable angina is differentiated from stable angina in that the pain may:

• Occur at rest
• Be new in conditions of onset or last longer than previous anginal attacks
• Be less responsive to medication

In other words, if a pattern of stable angina has been present previously, the development of unstable angina may be defined by a change in the pattern, frequency, or severity of the pain. If a pattern of stable angina has not been present previously, the beginning of chest pain episodes also constitutes unstable angina.

• Physical examination may reveal a change in blood pressure . Transient heart murmur or arrhythmias (irregular heartbeats) may occur as well.
• ECG changes that occur at rest, during pain, are often diagnostic.
• Heart scans or coronary angiography of the heart are often performed.
• Echocardiography may reveal changes in the heart caused by decreased coronary blood flow.
• Blood tests such as CPK, CPK-MB, troponin I, troponin T, and myoglobin are used to diagnose unstable angina and can predict likelihood of progression to heart attack.

Review Date: 05/31/2006
Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.