> -----Original Message-----
> From: Rowley Cottingham [mailto:[log in to unmask]]
> Unstable angina is cardiac chest pain that
> lasts for more than 20 minutes at rest or
> is associated with pulmonary oedema, hypotension and/or tachycardia
> has ECG changes, particularly ST segment depression in more
> than two leads or
> occurs after recent MI or cardiac surgery (within 14 days) or
> has an elevated serum troponin level.
Not sure if I agree 100% with your definition. My understanding is that
unstable angina is rest pain; increasing severity or frequency of stable
angina or new onset angina with frequent or severe attacks.
Presence of ECG changes or pulmonary oedema (or possible HS 3/4) is
predictive of severe stenosis; but is not needed for the diagnosis (clearly
frank cardiogenic shock is different). (The difference being that patients
without these changes are likely- but not certain- to settle with medical
treatment; whereas those with changes are likely to require angioplasty etc.
Not so much of an issue in centres where trial of medical therapy is first
line treatment.)
The 'increasing frequency or severity with negative ECG and troponins' group
are different from our viewpoint as they are suitable for outpatient follow
up. Nevertheless, the have a significant 1 year mortality (based on pretty
poor evidence, but I haven't done a proper search and am prepared to be
corrected), and are important to subchronic physicians.
New treatments, new investigations. Maybe we should change the terminology
as what we have is a poor predictor of need for treatment and prognosis
(especially if you classify everything from increased frequency of attacks
to cardiogenic shock as 'unstable angina'. Different people define the term
differently, so we may have to be more precise as to whether we mean rest
pain; increasing pain with 'ischaemic' ECG; pain with elevated troponins
etc; or alternatively 'reversible ischaemia with blah de blah findings' kind
of thing.
md
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