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Alternative Names Return to topAccelerating angina; New-onset angina; Angina - unstable; Progressive angina
Definition Return to top
Unstable angina is a condition in which your heart doesn't get enough blood flow and oxygen. It is a prelude to a heart attack. Most people experience a feeling of chest discomfort or shortness of breath.
Causes Return to top
Coronary artery disease due to atherosclerosis is by far the most common cause of unstable angina. Atherosclerosis is the buildup of fatty material called plaque along the walls of the arteries. This causes arteries to become less flexible and narrow, which interrupts blood flow to the heart, causing chest pain.
At first, angina may be considered stable. The chest pain only occurs with activity or stress. The pain does not change much in frequency or severity over time. Unstable angina is chest pain that is sudden and gets increasingly worse. The chest pain:
People with unstable angina are at increased risk of having a heart attack.
Coronary artery spasm is a rare cause of angina.
Risk factors for coronary artery disease include:
Symptoms Return to top
If you have stable angina, you may be developing unstable angina if the chest pain:
Exams and Tests Return to top
The doctor will perform a physical examination and check your blood pressure. The doctor may hear abnormal sounds, such as a heart murmur or irregular heartbeat, when listening to your chest with a stethoscope.
Tests to diagnose angina include:
Treatment Return to top
Your doctor may want you to check into the hospital to get some rest and prevent complications.
Blood thinners (antiplatelet drugs) are commonly used to treat and prevent unstable angina. Such medicines include aspirin and the prescription drug clopidogrel. The two medicines are often used together. Aspirin (and sometimes clopidogrel) may reduce the chance of heart attack in certain patients.
During an unstable angina event, you may receive heparin and nitroglycerin. Other treatments may include medicines to control blood pressure, anxiety, abnormal heart rhythms, and cholesterol (such as a statin drug).
Often if a blood vessel is found to be narrowed or blocked, a procedure called angioplasty and stenting can be performed to open the artery.
Heart bypass surgery may be done for some people, depending on which and how many of their coronary arteries are narrowed and the severity of the narrowing.
Outlook (Prognosis) Return to top
How well you do depends on many different things, including:
Arrhythmias and heart attacks can cause sudden death.
Possible Complications Return to top
Unstable angina may lead to a heart attack.
When to Contact a Medical Professional Return to top
Call your health care provider immediately if you develop symptoms of unstable angina.
Call your doctor if you have any symptoms of angina.
If you think you are having a heart attack, seek immediate medical treatment.
Prevention Return to top
Lifestyle changes can help prevent some angina attacks. Your doctor may tell you to:
You should also keep strict control of your blood pressure, diabetes, and cholesterol levels. Some studies have shown that making a few lifestyle changes can prevent blockages from getting worse and may actually improve them.
If you have one or more risk factors for heart disease, talk to your doctor about possibly taking aspirin or other medicines to help prevent a heart attack. Aspirin therapy (75 - 325 mg a day) or a drug called clopidogrel may help prevent heart attacks in some people. Aspirin therapy is recommended if the benefit is likely to outweigh the risk of gastrointestinal side effects.
References Return to top
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr., et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157.
Antman EM. ST-Elevation Myocardial Infarction: Management. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.Update Date: 4/23/2009 Updated by: Steven Kang, MD, Division of Cardiac Pacing and Electrophysiology, East Bay Arrhythmia, Cardiovascular Consultants Medical Group, Oakland, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.