Unstable angina / non ST elevation myocardial infarction diagnosis
| 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 |
| Cardiology Network |
 Discuss Unstable angina / non ST elevation myocardial infarction diagnosis further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
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| Hypertension |
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| Peripheral Arterial Disease |
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| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
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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
Diagnosis of Unstable Angina Pectoris
Laboratory Findings
Electrolyte and Biomarker Studies
If there is an elevation of a marker of myocardial necrosis (CK-MB or troponin), then the patient does not have unstable angina, but instead has a syndrome of either ST elevation MI or Non ST elevation MI depending upon the EKG changes.
Electrocardiogram
The resting electrocardiogram may show either
- No changes
- Non specific ST T wave changes
- Flipped or inverted T waves
- ST Depression as shown below. ST depression carries the poorest prognosis. Greater magnitudes of downsloping ST depression are associated with a poorer prognosis.
Chest X Ray
A chest X-ray is critical to aid in the exclusion of aortic dissection. A mediastinal mass consistent with a cancer may be present, but it is unlikely to present with a syndrome of accelerating chest pain. The chest X ray is critical in assessing for the presence of pulmonary edema or congestive heart failure which requires urgent treatment and confers a poorer prognosis.
Echocardiography
Segmental wall motion abnormalities can occur within minutes of coronary artery occlusion and can be useful in establishing that the pain is of cardiac origin and in determining the myocardial territory that is at risk.
Coronary Angiography
An early invasive strategy including coronary angiography may be required if aggressive medical therapy fails to stabilize the patient, if prior revascularization procedures have been performed, in the presence of recurrent angina, and in the presence of abnormal non-invasive test results.