Unstable angina

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 20 Apr 2026

Topic last updated: 13 May 2026

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 UA (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 angiography (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 treatment to prevent recurrence.

Definición

UA is an 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]

Anamnesis y examen

Principales factores de diagnóstico

chest pain

Todos los datos

Otros factores de diagnóstico

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

Todos los datos

Factores de riesgo

smoking
hypertension
diabetes mellitus
obesity and metabolic syndrome
sedentary behavior and physical inactivity
dyslipidemia
chronic kidney disease (CKD)
atherosclerosis (history of angina, myocardial infarction, 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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

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

Todos los datos

Tests to avoid

coronary artery calcium (CAC)

Todos los datos

Pruebas diagnósticas que deben considerarse

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

Todos los datos

Algoritmo de tratamiento

Inicial

suspected non-ST-elevation acute coronary syndrome

Agudo

non-ST-elevation acute coronary syndrome (unstable angina or non-ST-elevation myocardial infarction)

En curso

poststabilization: confirmed unstable angina

Colaboradores

Consejeros especializados

Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston, TX

Divulgaciones

SWY declares that he has no competing interests.

Agradecimientos

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

Divulgaciones

IND declares that he has no competing interests.

Revisores por pares

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor, MI

Divulgaciones

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

Divulgaciones

ZI declares that he has no competing interests.

Helge Mollmann, MD

Kerckhoff Heart and Thorax Center

Bad Nauheim

Germany

Divulgaciones

HM declares that he has no competing interests.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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 Resumen

Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2025 Apr;151(13):e771-862.Texto completo Resumen

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 Resumen

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 Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Stable angina
- Prinzmetal (variant or vasospastic) angina
- Non-ST-elevation myocardial infarction
Más Diferenciales
Guías de práctica clínica
- 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes
- 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
Más Guías de práctica clínica
Calculadoras
ASCVD Risk Estimator Plus
Thrombolysis in Myocardial Infarction (TIMI) Score for Unstable Angina Non ST Elevation Myocardial Infarction
Más Calculadoras
Videos
Venepuncture and phlebotomy: animated demonstration
How to perform an ECG: animated demonstration
Más vídeos
Folletos para el paciente
Unstable angina: what is it?
Heart attack
Más Folletos para el paciente
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Unstable angina

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Tests to avoid

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

suspected non-ST-elevation acute coronary syndrome

non-ST-elevation acute coronary syndrome (unstable angina or non-ST-elevation myocardial infarction)

poststabilization: confirmed unstable angina

Colaboradores

Consejeros especializados

Syed Wamique Yusuf, MBBS, FRCPI

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

John Charpie, MD, PhD

Divulgaciones

Zaza Iakobishvili, MD, PhD

Divulgaciones

Helge Mollmann, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Calculadoras

Videos

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice