Unstable angina

Most commonly presents with chest pain and/or dyspnea, although atypical symptoms may be present.

Initial risk stratification and management depends on the clinical features and ECG.

ECG typically shows ST segment depression and T-wave inversion, but may be normal.

Acute management includes antiplatelet and antithrombotic therapy to reduce the extent of myocardial damage and complications.

Long-term management includes reduction of risk factors and medication to prevent recurrence.

Unstable angina (UA) is an acute coronary syndrome that is defined by the absence of biochemical evidence of myocardial damage.[1]Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267-315. http://eurheartj.oxfordjournals.org/content/37/3/267.long http://www.ncbi.nlm.nih.gov/pubmed/26320110?tool=bestpractice.com 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]Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267-315. http://eurheartj.oxfordjournals.org/content/37/3/267.long http://www.ncbi.nlm.nih.gov/pubmed/26320110?tool=bestpractice.com