Related articles: Unstable Angina
Definition
Unstable angina is a clinical syndrome caused, more often than not, by an acute occlusion - almost complete, but not total - of a coronary artery by a thrombus rich in platelets and fibrin. The severity of this condition is intermediate between that of stable angina and that of myocardial infarction.
Other risk factors for the development of this syndrome include atherosclerosis, hypertension and arterial embolism.
The patient with unstable angina can present three main clinical pictures:
- New onset angina (within the last two months): angina of severity equal to class 3 or 4 of the Canadian Cardiovascular Society Classification (CCSC), angina at rest (often prolonged) or both first situations;
- Aggravation of a pre-existing angina (within two months of onset): the anginal episodes are clearly more frequent, more intense, of longer duration or with a lower onset threshold;
- Post-infarct angina (within two weeks of infarction).
Most common symptoms and signs *
- Arrhythmia
- Asthenia
- Retrosternal burning
- Heartburn
- palpitations
- Bad digestion
- Dyspnoea
- Abdominal pain
- Neck pain
- Chest pain
- Pain in the Stomach Mouth
- Jaw pain
- Hand and wrist pain
- Pain in the upper part of the abdomen
- Shoulder pain
- Pain in the sternum
- Pain associated with chewing
- Back pain
- heartburn
- Belching
- Shortness of breath
- Tingling in the Left Arm
- Tingling in the hands
- Hypercapnia
- Hypoxia
- Restlessness
- Nausea
- presyncope
- Muscle spasms
- Sweating
- Fainting
- He retched
Further indications
The symptoms of unstable angina depend on the degree and location of the coronary obstruction, but generally include severe, prolonged and very intense chest pain, with or without dyspnea, nausea and diaphoresis (excessive sweating).
Compared to angina pectoris (stable), the feeling of oppression felt in the retrosternal area is generally more intense, develops for prolonged times (up to 20 minutes) and can be worsening (ie progressively increases in severity).
Chest pain also arises due to minor strains or occurs spontaneously at rest; furthermore, it can radiate up to the back, the throat, the jaw, the shoulders and, occasionally, the arms and hands. Unstable angina can also manifest itself with fatigue, restlessness, weakness and difficulty in digestion.
After the acute event, many complications can occur. These usually include electrical dysfunction (such as arrhythmias and conduction defects), myocardial dysfunction (eg heart failure, interventricular septal rupture, ventricular aneurysm, mural thrombus and cardiogenic shock) or valvular (mitral regurgitation).
The diagnosis of unstable angina is based on the finding of alterations to the electrocardiogram (inversion of the T wave and sub-leveling or elevation of the ST segment) and on the presence or absence of serological markers (among cardiac enzymes creatine kinase is not high, but the troponin is increased). Other investigations useful for diagnostic assessment include exercise tests, coronary angiography and echocardiography.
The treatment of unstable angina uses antiplatelet drugs, anticoagulants, nitroderivatives, beta-blockers and percutaneous angioplasty or, occasionally, aorto-coronary bypass.
