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'''Synonyms and related keywords''': progressive angina, crescendo angina, accelerating angina, new-onset angina, pre-infarction angina, unstable angina pectoris, UAP, UA  
'''''Synonyms and related keywords''':'' progressive angina, crescendo angina, accelerating angina, new-onset angina, pre-infarction angina, unstable angina pectoris, UAP, UA  


==The Spectrum of Acute Coronary Syndromes==
==The Spectrum of Acute Coronary Syndromes==

Revision as of 12:14, 22 May 2009

Unstable angina pectoris
Plaque rupture in a coronary artery at arrows yielding obstructive thrombus in red.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
ICD-10 I20
ICD-9 413
DiseasesDB 8695
eMedicine med/133 
MeSH D000787

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Synonyms and related keywords: progressive angina, crescendo angina, accelerating angina, new-onset angina, pre-infarction angina, unstable angina pectoris, UAP, UA

The Spectrum of Acute Coronary Syndromes

Unstable angina and non ST elevation MI are part of the spectrum of acute coronary syndromes (ACS). ACS is a term that encompasses unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). All these underlying diseases result from an inadequate supply to meet the oxygen and metabolic demands of the myocardium. While all three usually result from atherosclerotic plaque rupture and subsequent thrombus formation in one of the main epicardial coronary arteries, there are other possible etiologies of this imbalance such as coronary artery narrowing alone, coronary spasm, or coronary dissection. UA, NSTEMI and STEMI are distinguished pathophysiologically as to whether or not the thrombus is occlusive (as in the case of STEMI) or non-occlusive (as in the case of UA and NSTEMI). If an electrocardiogram (EKG) is performed at the time that an occlusive coronary artery thrombus is formed, it will usually show ST-segment elevation in the leads which correspond to the territory of myocardium in which blood supply has been disrupted (see STEMI). If an EKG is performed at the time that a non-occlusive thrombus is formed, it may or may not show signs of ischemia. [1] [2]

Definition of Non ST Elevation MI

UA and NSTEMI are differentiated from each other based upon whether there are elevated serum levels of cardiac biomarkers (i.e., creatine kinase (CK), MB isoenzyme of CK (CK-MB) and Troponins I and T). Elevated cardiac biomarkers are present in NSTEMI but not in UA. However, it is important to note that although troponins are fairly sensitive and specific for myocardial necrosis, the diagnosis of NSTEMI should not be made based on laboratory findings alone, as there are other possible etiologies for elevated troponins. [1] [2] For the diagnosis of non ST elevation MI to be made, the troponin elevation must occur in the context of ischemic chest pain.

Definition of Unstable Angina Pectoris

Unstable angina pectoris is chest pain which is ischemic in origin and either occurrs more frequently, lasts longer, and/or manifests with lesser degrees of exertion than stable angina. It can occur at rest and/or at night. Unlike ST elevation MI (STEMI) or non ST elevation MI (NSTEMI), there no sign of myocardial necrosis and there is no release of biomarkers of myonecrosis (CK or troponin) in unstable angina pectoris. [3] [4] [5] [6] [7] [8] [9] [10] [11] [1] [2] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] [54] [55] [56] [57] [58] [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] [69] [70] [71] [72] [73] [74] [75] [76] [77] [78] [79] [80] [81] [82] [83] [84] [85] [86] [87] [88] [89] [90] [91] [92] [93] [94] Angina pectoris is classified as stable when its characteristics are unchanged for 60 days. Stable angina pectoris usually responds to sublingual nitroglycerin or rest. Unstable angina may occur at rest and may be unrelieved by rest.

References

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  90. ↑ Tanabe Y, Itoh E, Suzuki K, et al: Limited role of coronary angioplasty and stenting in coronary spastic angina with organic stenosis. J Am Coll Cardiol 2002; 39:1120-1126. PMID 11923034
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