Cardiology
Unstable Angina
불안정협심증
New or rest angina with negative troponin
- How common
- Common ED chest pain
- Typical age
- Ages 50+
What is it?
Vulnerable plaque rupture with transient non-occlusive thrombus → angina at rest or minimal exertion.
Commonly affected: Coronary stenosis sites
How it develops
- Vulnerable plaqueThin fibrous cap, large lipid core
- Focal thrombosisTransient non-occlusive thrombus
- Coronary spasmCo-existing spasm worsens ischemia
- MI riskUntreated → 10-20% MI within 30 days
Symptoms
- Rest anginaChest pain at rest
- New-onset anginaNew within 6 wks
- Crescendo anginaIncreased frequency/intensity
- Reduced nitro responseLess effective than before
How it is examined
- ECGST depression/T inversion possible (or normal)
- TroponinNegative defines UA (positive = NSTEMI)
Imaging
Usually normal.
- Normal or nonspecific
Coronary angiography within 24-72 hrs recommended.
- Stenosis/non-occlusive thrombus
Non-surgical care
- DAPTAspirin + clopidogrel/ticagrelor
- AnticoagulationEnoxaparin or heparin
- Anti-ischemicBB, nitroglycerin, CCB
- High-intensity statinAtorvastatin 80mg
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
High-risk or failed medical therapy
Procedures that may be discussed
- PCI
- CABG (multivessel/left main)
Outlook
Low mortality with aggressive therapy; delayed diagnosis → MI/death risk.