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Unstable angina

Last reviewed: 13 Feb 2025
Last updated: 11 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • Chest pain
Full details

Other diagnostic factors

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

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

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

Tests to avoid

  • coronary artery calcium (CAC)
Full details

Tests to consider

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

Treatment algorithm

INITIAL

presumed cardiac chest pain

ACUTE

non-ST-elevation acute coronary syndrome

ONGOING

poststabilization: confirmed UA (nonelevated cardiac biomarkers)

Contributors

Authors

Syed Wamique Yusuf, MBBS, FRCPI
Syed Wamique Yusuf

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

Acknowledgements

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

Disclosures

IND declares that he has no competing interests.

Peer reviewers

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

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

Disclosures

ZI declares that he has no competing interests.

Helge Mollmann, MD

Kerckhoff Heart and Thorax Center

Bad Nauheim

Germany

Disclosures

HM declares that he has no competing interests.

  • Unstable angina images
  • Differentials

    • Stable angina
    • Prinzmetal (variant or vasospastic) angina
    • Non-ST-elevation myocardial infarction
    More Differentials
  • Guidelines

    • 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
    More Guidelines
  • Patient information

    Unstable angina: what is it?

    Unstable angina: what treatments work?

    More Patient information
  • Calculators

    Thrombolysis in Myocardial Infarction (TIMI) Score for Unstable Angina Non ST Elevation Myocardial Infarction

    GRACE Score for Acute Coronary Syndrome Prognosis

    More Calculators
  • Videos

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    How to perform an ECG: animated demonstration

    More videos
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