Unstable angina

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Última revisão: 4 May 2025

Última atualização: 29 Apr 2025

Unstable angina (UA) should be suspected based on: the presence of symptoms suggestive of myocardial ischemia (e.g., acute chest pain); ECG findings (no evidence of ST-elevation myocardial infarction); and the result of troponin testing (no dynamic elevation of cardiac troponin (hs-cTn) above the 99th percentile).

A resting 12-lead ECG should be recorded and interpreted within 10 minutes of the point of first medical contact in any patient with suspected unstable angina (and other acute coronary syndromes [ACS]).

In patients with suspected ACS, nonelevated (or uncertain) hs-cTn levels, no ECG changes and no recurrence of pain, a noninvasive stress imaging test or coronary computed tomography angiograph (CCTA) should be considered as part of initial evaluation.

Acute management includes antiplatelet and anticoagulant therapy to reduce the extent of myocardial damage and complications. Further management is based on the results of troponin testing and risk assessment. This may include dual antiplatelet therapy and an invasive strategy or noninvasive investigation.

Long-term management should aim to modify risk factors for cardiovascular disease and use of drug to prevent recurrence.

Definição

Unstable angina (UA) is an acute coronary syndrome (ACS) that is defined as myocardial ischemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis.[1] It is characterized by specific clinical findings of prolonged (>20 minutes) angina at rest; new onset of severe angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of myocardial infarction.[1]

História e exame físico

Principais fatores diagnósticos

Chest pain

Detalhes completos

Outros fatores diagnósticos

diaphoresis
epigastric pain
dyspnea
nausea and vomiting
carotid bruit
diminished or absent peripheral pulses
syncope
back pain
arrhythmias
abnormal heart sounds
rales

Detalhes completos

Fatores de risco

smoking
hypertension
diabetes mellitus
obesity and metabolic syndrome
sedentary behavior and physical inactivity
dyslipidemia
chronic kidney disease (CKD)
atherosclerosis (history of angina, MI, stroke, transient ischemic attack, peripheral vascular disease)
family history of premature CAD
age >60 years
cocaine use
depression
sleep apnea
elevated C-reactive protein levels
mediastinal radiation
migraine
adverse pregnancy outcomes

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

ECG
cardiac biomarkers
CXR
CBC
electrolytes and renal function
LFTs
blood sugar
CRP
lipid profile
coagulation profile

Detalhes completos

Tests to avoid

coronary artery calcium (CAC)

Detalhes completos

Investigações a serem consideradas

echocardiogram
coronary angiography
functional (stress) testing
coronary CT angiography
CT chest or MRI

Detalhes completos

Algoritmo de tratamento

Inicial

presumed cardiac chest pain

AGUDA

non-ST-elevation acute coronary syndrome

CONTÍNUA

poststabilization: confirmed UA (nonelevated cardiac biomarkers)

Colaboradores

Autores

Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

Declarações

SWY declares that he has no competing interests.

Agradecimentos

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Iyad N. Daher, the previous contributor to this topic.

Declarações

IND declares that he has no competing interests.

Revisores

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

Declarações

JC declares that he has no competing interests.

Zaza Iakobishvili, MD, PhD

Director

Emergency Cardiac Service ICCU

Department of Cardiology

Rabin Medical Center

Petah Tikva

Israel

Declarações

ZI declares that he has no competing interests.

Helge Mollmann, MD

Kerckhoff Heart and Thorax Center

Bad Nauheim

Germany

Declarações

HM declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.Texto completo Resumo

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-228.Texto completo Resumo

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.Texto completo Resumo

Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18-114.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
Mais Diagnósticos diferenciais
Diretrizes
- 2023 ESC guidelines for the management of acute coronary syndromes
- European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases
Mais Diretrizes
Folhetos informativos para os pacientes
Unstable angina: what is it?
Heart attack
Mais Folhetos informativos para os pacientes
Calculadoras
ASCVD Risk Estimator Plus
Thrombolysis in Myocardial Infarction (TIMI) Score for Unstable Angina Non ST Elevation Myocardial Infarction
Mais Calculadoras
Videos
Venepuncture and phlebotomy: animated demonstration
How to perform an ECG: animated demonstration
Mais vídeos
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Unstable angina

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Tests to avoid

Investigações a serem consideradas

Algoritmo de tratamento

presumed cardiac chest pain

non-ST-elevation acute coronary syndrome

poststabilization: confirmed UA (nonelevated cardiac biomarkers)

Colaboradores

Autores

Syed Wamique Yusuf, MBBS, FRCPI

Declarações

Agradecimentos

Declarações

Revisores

John Charpie, MD, PhD

Declarações

Zaza Iakobishvili, MD, PhD

Declarações

Helge Mollmann, MD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Calculadoras

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice