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Angina instável

Last reviewed: 13 Feb 2025
Last updated: 07 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • aumento na frequência da dor torácica
  • aumento na intensidade da dor torácica
  • dor torácica retroesternal que irradia à mandíbula, aos braços e ao pescoço
  • dispneia
  • quarta bulha cardíaca (B4)
Full details

Other diagnostic factors

  • desconforto torácico atípico
  • diaforese
  • náuseas
  • taquicardia
  • sopro carotídeo
  • pulsos periféricos reduzidos ou ausentes
  • síncope
  • terceira bulha cardíaca (B3)
  • sopros
  • estertores
Full details

Risk factors

  • sexo feminino
  • história pessoal de doença arterial coronariana (DAC)
  • envelhecimento
  • história familiar de DAC
  • hipertensão
  • tabagismo
  • diabetes mellitus
  • hiperlipidemia
  • doença vascular periférica
  • doença renal crônica
  • níveis elevados de proteína C-reativa
  • radiação do mediastino
  • obesidade/sedentarismo
Full details

Diagnostic investigations

1st investigations to order

  • eletrocardiograma (ECG)
  • biomarcadores cardíacos
  • Hemograma completo
  • eletrólitos e função renal
  • glicemia
  • perfil lipídico
  • perfil de coagulação
  • radiografia torácica
  • ecocardiograma: em repouso
  • estudo de perfusão miocárdica: repouso
  • tomografia computadorizada (TC) do tórax ou ressonância nuclear magnética (RNM)
  • angiografia coronariana
Full details

Investigations to consider

  • ecocardiograma: em esforço
  • estudo de perfusão miocárdica: estresse
  • angiotomografia coronária
Full details

Treatment algorithm

INITIAL

dor torácica presumivelmente cardíaca

ACUTE

síndrome coronariana aguda sem supradesnivelamento do segmento ST

ONGOING

angina instável (AI) confirmada (biomarcadores cardíacos não elevados)

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.

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