Unstable angina is a condition in which your heart doesn't get enough blood flow and oxygen. It may be a prelude to a heart attack.
Angina is a type of chest discomfort caused by poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).
Accelerating angina; New-onset angina; Angina - unstable; Progressive angina
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 become more frequent or severe 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.
Risk factors for coronary artery disease include:
If you have stable angina, you may be developing unstable angina if the chest pain:
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 evaluate angina include:
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. Aspirin (and sometimes clopidogrel) may reduce the chance of a heart attack in certain patients.
During an unstable angina event, you may receive heparin (or another blood thinner) and nitroglycerin (under the tongue or through an IV). 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 narrowings.
How well you do depends on many different things, including:
Arrhythmias and heart attacks can cause sudden death.
Unstable angina may lead to a heart attack.
Seek medical attention if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.
Call 911 if your angina pain:
Call your doctor if:
If you think you are having a heart attack, seek immediate medical treatment.
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.
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.