UNSTABLE ANGINA Dr Abdul Mateen Ansari MD Professor

UNSTABLE ANGINA Dr Abdul Mateen Ansari, MD Professor and HOD General Medicine, CIMSH, LUCKNOW

IHD – may be of 2 types a) CAD with Stable Angina b) Acute Coronary Syndrome ( ACS) ACS can further be divided into 2 types – a) Acute MI with ST Elevation b) b) Unstable Angina ( UA) / Non ST Elevation MI( NSTEMI) Yearly in US 1. 3 million patients are admitted with UA / NSTEMI Incidence of UA is Increasing and 50% of cases are Females.

� 3 Lacs patients are admitted with ST Elevation MI. � out of them ¾ are males. STABLE ANGINA�This is Chest Discomfort associated with Exertion and relieved by Rest ( 5 -10 min) OR By Sublingual Nitroglycerine.

UNSTABLE ANGINA(UA) UA is defined as Angina Pectoris with at least one of the features— � 1) It occurs at Rest or with minimal Exertion usually for > 10 min. � 2) It is severe and of new onset ( 4 to 6 weeks only) � 3) It occurs with Crescendo patterns ( severity/ frequency/duration)

DIAGNOSIS is made BY� 1) CLINICAL FEATURES � 2) ECG – ST Depression , Transient ST Elevation or T Inversion � 3) Cardiac Bio-Markers- CK-MB, TROP T & TROP I

PATHO-PHYSIOLOGY OF UA Atherosclerotic Plaque leads to narrowing of lumen of coronary artery, Leading to decreased blood supply to Myocardium (ISCHAEMIA) Coronary Angiography reports of UA / NSTEMI patients reveal – � 40% have Single vessel disease (SVD ) � 30% have Double vessel disease (DVD) � 15 % have Triple vessel disease (TVD) � 10% have no findings � 05% have Left Main Artery Disease

distribution of coronary artery

CLINICAL PRESENTATION 1 - Chest Pain – Sub-sternal with radiation to Left shoulder or arm. - Pain is usually Severe 2 - Angina Equivalentsa) Dyspnoea b) Epigastric Discomfort 3 - Sweating

4 - Pale cool skin 5 - Hypotension 6 - Sinus Tachycardia 7 – S 3 & S 4 Heart Sounds 8 - Basilar Rales

TREATMENT 1 - BED REST with CARDIAC MONITORING 2 – ANTI ISCHAEMIC TREATMENT – A) NITRATES – NITROGLYCERINE – Sublingual / IV Route B ) BETA BLOCKERS– METOPROLOL C ) CALCIUM CHANNEL BLOCKERS D ) MORPHINE – IV route for Symptoms relief

3 – ANTI – THROMBOTIC TREATMENTA) ORAL – Aspirin & Clopidogrel B ) IV -- Abciximab , Eptifibatide & Tirofiban 4– HEPARIN– A) Un-fractional B) Fractional – Enoxaparin 5 – ANTI-LIPID TREATMENT 6 – Invasive ANGIOGRAPHY in high risk patients

7 – Treatment of other medical problems like DM, HTN & THYROID Disorders. 8– Life style modification 9 – Diet and Obesity control 10 - Excercise

PREVENTION

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