Angina pectoris is a term that refers to myocardial ischemia (lack of oxygenated blood to heart muscle) that results in a classic picture with central chest tightness or heaviness brought on by exertion and relieved by rest.
Unstable angina refers to any of the following :
➳ Angina of recent onset
➳ Angina increasing in severity or frequency or duration.
➳ Angina at rest or minimal exertion.
Causes
✫ Usually atheroma
✫ Anemia
✫ Thyrotoxicosis
✫ Arteritis
✫ Hypertrophic obstructive cardiomyopathy
Risk Factors
✈ Age: the incidence increases with age, the incidence being 1.5 in 1000 at the age of 50. The mean age is 62 years old with 40% of patients over the age of 65.
✈ Gender: Males are more prone than females (especially premenopausal women). Males are 5 times more prone to develop the disease at the age of 50.
✈ Serum cholesterol: A ratio of LDL to HDL of greater than 4:1 increases the risk dramatically. Conversely, a higher HDL level seems to offer protection. Serum cholesterol levels should be kept below 200mg/dL.
✈ Smoking: increases the incidence by 60%.
✈ Hypertension: whether systolic or diastolic tends to increase the risk.
✈ Diabetes mellitus: is known to increase the incidence of IHD both in males and females.
✈ Oral contraceptives is associated with an increased incidence of myocardial infarction.
✈ Other: Gout, Type A personality, premature arcus corneae, obesity, hypertriglyceridemia and diagonal ear lobe crease have all been reported to increase the risk of developing ischemic heart disease.
Related Article :
- Myocardial Infarction (Heart Attack)
- Myocarditis (Inflammatory Cardiomyopathy)
- Broken Heart Syndrome (BHS)
Diagnosis
✍ ECG shows down-slope of the ST segment during an attack or stress test.
✍ The principle problem is to differentiate between those with unstable angina and those with non-Q wave myocardial infarction. This is established by finding elevated enzymes in cases of myocardial infarction.
Treatment
♥ Keep in mind the risk of myocardial infarction with unstable angina .
♥ Hospitalization
♥ Rest, correct precipitating and risk factors
♥ Treatment of ischemia :
- IV nitroglycerin is preferred due to easy establishment of drug levels.
- Beta blockers
- 2nd line Ca++ channel blocker
♥ Inhibition of thrombosis :
- Heparin is given a bolus of 80 units/kg followed by 18units/kg/hr infusion. A heparin ampoule is 5000 U and the antidote is protamine sulfate 50mg over 10 mints IV.
- Aspirin
♥ Symptomatic :
- Morphine reserved for pain that is refractory to medical treatment (it also has a mild VD effect).
♥ Special situations :
- Thrombolytic agents are used only in patients with persistant ST segment elevation or new LBBB.
- It increases the risk of MI.
- Intra-aortic balloon counterpulsation only used to stabilize patients indicated for PTCA or CABG.
Unstable angina refers to any of the following :
➳ Angina of recent onset
➳ Angina increasing in severity or frequency or duration.
➳ Angina at rest or minimal exertion.
Causes
✫ Usually atheroma
✫ Anemia
✫ Thyrotoxicosis
✫ Arteritis
✫ Hypertrophic obstructive cardiomyopathy
Risk Factors
✈ Age: the incidence increases with age, the incidence being 1.5 in 1000 at the age of 50. The mean age is 62 years old with 40% of patients over the age of 65.
✈ Gender: Males are more prone than females (especially premenopausal women). Males are 5 times more prone to develop the disease at the age of 50.
✈ Serum cholesterol: A ratio of LDL to HDL of greater than 4:1 increases the risk dramatically. Conversely, a higher HDL level seems to offer protection. Serum cholesterol levels should be kept below 200mg/dL.
✈ Smoking: increases the incidence by 60%.
✈ Hypertension: whether systolic or diastolic tends to increase the risk.
✈ Diabetes mellitus: is known to increase the incidence of IHD both in males and females.
✈ Oral contraceptives is associated with an increased incidence of myocardial infarction.
✈ Other: Gout, Type A personality, premature arcus corneae, obesity, hypertriglyceridemia and diagonal ear lobe crease have all been reported to increase the risk of developing ischemic heart disease.
Related Article :
- Myocardial Infarction (Heart Attack)
- Myocarditis (Inflammatory Cardiomyopathy)
- Broken Heart Syndrome (BHS)
Diagnosis
✍ ECG shows down-slope of the ST segment during an attack or stress test.
✍ The principle problem is to differentiate between those with unstable angina and those with non-Q wave myocardial infarction. This is established by finding elevated enzymes in cases of myocardial infarction.
Treatment
♥ Keep in mind the risk of myocardial infarction with unstable angina .
♥ Hospitalization
♥ Rest, correct precipitating and risk factors
♥ Treatment of ischemia :
- IV nitroglycerin is preferred due to easy establishment of drug levels.
- Beta blockers
- 2nd line Ca++ channel blocker
♥ Inhibition of thrombosis :
- Heparin is given a bolus of 80 units/kg followed by 18units/kg/hr infusion. A heparin ampoule is 5000 U and the antidote is protamine sulfate 50mg over 10 mints IV.
- Aspirin
♥ Symptomatic :
- Morphine reserved for pain that is refractory to medical treatment (it also has a mild VD effect).
♥ Special situations :
- Thrombolytic agents are used only in patients with persistant ST segment elevation or new LBBB.
- It increases the risk of MI.
- Intra-aortic balloon counterpulsation only used to stabilize patients indicated for PTCA or CABG.
Related Article :
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