What is the difference between unstable angina and mi

The complications of acute coronary syndromes depend on how much of the heart muscle is damaged which is a direct result of where a coronary artery was blocked and how long this artery was blocked. If the blockage shuts off blood flow to the electrical system of the heart, the heart rhythm may be affected, possibly leading to arrhythmia Overview of Abnormal Heart Rhythms Abnormal heart rhythms arrhythmias are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart.

Heart disorders are Sometimes a person can be revived after cardiac arrest, particularly if treatment is Whenever a man over age 35 or a woman over age 40 reports chest pain Chest Pain Chest pain is a very common complaint. Pain may be sharp or dull, although some people with a chest disorder describe their sensation as discomfort, tightness, pressure, gas, burning, or aching But several other conditions can cause similar pain: pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs alveoli and the tissues around them.

Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final Rib fractures cause severe pain, particularly when a person breathes deeply. A chest x-ray is usually taken. People are given The cause of this disorder is not known. Symptoms include chest pain and difficulty People may also describe the sensation as gassiness, a sense of fullness, or gnawing or burning. The sense of fullness may occur after This record, the electrocardiogram also known as an ECG This procedure provides a graphic representation of the electrical current producing each heartbeat.

In many instances, it immediately shows that a person is having a heart attack. Abnormalities detected by ECG help doctors determine the type of treatment needed. The abnormalities on ECG also help show where the heart muscle was damaged. If a person has had previous heart problems, which can alter the ECG, the most recent damage may be harder for doctors to detect.

Such people should carry a small copy of their ECG in their wallets, so that if they have symptoms of an acute coronary syndrome, doctors can compare the previous ECG with the current ECG.

If a few ECGs recorded over several hours are completely normal, doctors consider a heart attack unlikely. Measuring levels of certain substances called cardiac markers in the blood also helps doctors diagnose acute coronary syndromes.

These substances are normally found in heart muscle but are released into the blood only when heart muscle is damaged or dead. Most commonly measured are heart muscle proteins called troponin I and troponin T and an enzyme called CK-MB creatinine kinase, myocardial band subunit. Levels in the blood are elevated within 6 hours of a heart attack and remain elevated for several days.

Levels of cardiac markers are usually measured when the person is admitted to the hospital and at 6- to hour intervals for the next 24 hours.

When ECG and cardiac marker measurements do not provide enough information, echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography uses high-frequency ultrasound waves bounced off internal structures to produce a moving image. It uses no x-rays. Ultrasonography of the heart echocardiography is one of The amount of radiation the person receives from the radionuclide Echocardiography may show reduced motion in part of the wall of the left ventricle the heart chamber that pumps blood to the body.

This finding suggests damage due to a heart attack. Other tests may be done during or shortly after hospitalization. These tests are used to determine whether a person needs additional treatment or is likely to have more heart problems. This can detect abnormalities that are constant; however, sometimes abnormal heart rhythms This procedure enables doctors to detect whether the person has abnormal heart rhythms arrhythmias or episodes of inadequate blood supply without symptoms silent ischemia.

An exercise stress test Stress Testing Stressing the heart by exercise or by use of stimulant drugs to make the heart beat faster and more forcibly can help identify coronary artery disease. In coronary artery disease, blood flow If these procedures detect abnormal heart rhythms or ischemia, drug therapy Drug Treatment of Coronary Artery Disease The heart muscle needs a constant supply of oxygen-rich blood.

Coronary artery disease that If ischemia persists, doctors may recommend coronary angiography Cardiac Catheterization and Coronary Angiography Cardiac catheterization and coronary angiography are minimally invasive methods of studying the heart and the blood vessels that supply the heart coronary arteries without doing surgery. The most dangerous time for someone who is having a heart attack is during the first few hours and before they go to a hospital. During this period, up to 20 to 30 percent of people with a heart attack may die, so it is critical to seek medical attention immediately when people suspect they are having a heart attack.

Most deaths occur in the first 3 or 4 months, typically in people who continue to have angina, abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms arrhythmias are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart.

The prognosis is worse if the heart has enlarged after a heart attack than if heart size remains normal. Older people are more likely to die after a heart attack and to have complications, such as heart failure. The prognosis for smaller people is worse than that for larger people. This finding may help explain why the prognosis for women who have had a heart attack is, on average, worse than that for men.

Women also tend to be older and to have more serious disorders when they have a heart attack. Also, they tend to wait longer after a heart attack to go to the hospital than do men. For people who have had a heart attack, doctors recommend taking one baby aspirin , one half of an adult aspirin , or one full adult aspirin daily.

People with an allergy to aspirin may take clopidogrel instead. For people who have not had a heart attack but who are over 50 years of age and have 2 or more risk factors Risk Factors Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked.

However, aspirin can sometimes cause complications such as gastrointestinal bleeding Gastrointestinal Bleeding Bleeding may occur anywhere along the digestive gastrointestinal [GI] tract, from the mouth to the anus.

Blood may be easily seen by the naked eye overt , or blood may be present in amounts Doctors help people weigh their individual risk and benefit. The more serious the heart attack, the more benefit beta-blockers provide.

However, some people cannot tolerate the side effects such as wheezing, tiredness, erectile dysfunction Erectile Dysfunction ED Erectile dysfunction ED is the inability to attain or sustain an erection satisfactory for sexual intercourse. See also Overview of Sexual Dysfunction in Men.

Every man occasionally has Taking lipid-lowering drugs will reduce the risk of death after a heart attack. People at high risk especially obese people with diabetes who have not yet had a heart attack or stroke may benefit from lipid-lowering drugs.

Angiotensin-converting enzyme ACE inhibitors, such as captopril , enalapril , perindopril, trandolapril , lisinopril , and ramipril , are often prescribed after a heart attack. These drugs help prevent death and the development of heart failure, particularly in people who have had a massive heart attack or who develop heart failure.

People should also make changes in their lifestyle. They should eat a low-fat diet and increase the amount of exercise they get. People who have high blood pressure or diabetes should try to keep those disorders under control.

People who smoke should quit. Acute coronary syndromes are medical emergencies. Half of deaths due to a heart attack occur in the first 3 or 4 hours after symptoms begin. The sooner treatment begins, the better the chances of survival. The differences between the types of acute coronary syndromes are discussed below. Anginal symptoms at rest that result in myocardial necrosis as identified by elevated cardiac biomarkers see Cardiac Enzymes Topic Review with no ST segment elevation on the lead ECG.

Anginal symptoms at rest that result in myocardial necrosis, as identified by elevated cardiac biomarkers see Cardiac Enzymes Topic Review with ST segment elevation on the lead ECG. When exposed to the bloodstream, tissue factor activates the clotting cascade, and thrombosis occurs. Tissue factor is exposed when the fibrous cap that covers the plaque becomes disrupted or ulcerated.

Some atherosclerotic plaques have a more stable fibrous cap. Others are thin and considered vulnerable. A clinically useful means to distinguish these types of plaque is not currently available. Unstable angina has a lower incidence of coronary thrombosis compared with non-ST segment elevation MI or ST segment elevation MIand is more often the result of fixed atherosclerotic stenosis.

Physical examination findings are relatively non-specific and similar to that described in the Stable Angina Topic Review. They are usually only present during the anginal episode, making this a less helpful means of diagnosis.

When examined during an anginal attack, the heart rate and blood pressure may be elevated due to increased sympathetic tone. A S4 heart sound may be present during myocardial ischemia due to the lack of adenosine triphosphate production impairing left ventricular relaxation.

Recall that myocardial relaxation is an active process requiring adenosine triphospate, or ATP, which is reduced during ischemia, and a S4 heart sound occurs when a non-compliant, stiffened left ventricle receives blood after atrial contraction because it is unable to relax adequately.

During inferior ischemia, posteromedial papillary muscle dysfunction can cause mitral regurgitation, resulting in a holosystolic murmur at the cardiac apex radiating to the axilla; see Heart Murmurs Topic Review.

This rarely occurs during anterior or lateral ischemia because the anterolateral papillary muscle has dual supply from the left anterior descending and circumflex coronary artery. When the left ventricular end-diastolic pressure, or LVEDP, increases during myocardial ischemia, that pressure can be transmitted backward to the pulmonary veins and into the pulmonary vasculature, causing transient pulmonary edema that results in dyspnea and rales on lung examination.

Physical examination, as previously described, is non-specific. The ECG tracing can have multiple abnormalities, but, by definition, there is no ST segment elevation. The most common finding is ST segment depression. This ST segment depression is horizontal or down-sloping in shape.

The T waves may be inverted, usually symmetrically. Observation in the hospital for cardiac enzymes in context of serial ECGs usually hours apart is required to completely exclude unstable angina and non-STEMI, as the ECG changes can be dynamic come and go and the findings normal initially. Also, cardiac enzymes troponin and creatine kinase require 3 to 4 hours after the injury before showing significant elevation; see Cardiac Enzymes Topic Review.

During unstable angina, however, there is no — or only very minimal — elevation. This is the main distinguishing feature between the two diagnoses. The symptoms of occlusive coronary artery disease can manifest as chronic stable angina pectoris or angina as a part of an ACS — both of which are similar, with the latter frequently occuring at rest.

Substernal chest pressure with radiation to the medial portion of the left arm or left jaw is the classic description. The pain from angina is gradual in onset and must last for at least 5 minutes. Also, the pain is diffuse and difficult to localize to one part of the chest; the description of a large vs. Less common presentations include only shoulder pain, pain down both arms, left wrist pain, right-sided chest or jaw pain, radiation to the right arm, mid-thoracic back pain and only dyspnea without chest pain.

Rarely, the pain of angina is described as sharp. Women, elderly patients and patients with diabetes tend to have more atypical presentations of angina. Many non-cardiac disease states can cause chest pain, as well. Esophageal spasm — a relatively uncommon cause of chest pain — can be relieved with nitroglycerine, causing it to mimic symptoms of angina.

Sharp, shooting chest pains lasting a few seconds to a minute are common and usually musculoskeletal related. When an atherosclerotic plaque ulcerates and thrombosis occurs, an ACS develops and the above-mentioned anginal symptoms can occur at rest.

This causes symptoms such as new-onset exertional angina, preexisting angina that is refractory to nitroglycerin, or angina at rest. The pathophysiology governing anginal symptoms is usually caused by atherosclerotic plaque that nearly obstructs coronary vessels. The distinguishing feature between unstable angina and non-STEMI is the presence of elevated cardiac markers, such as troponin, which implies myocardial damage. Patient history alone is insufficient to make a diagnosis of acute coronary syndrome.

The clinical dilemma of distinguishing between cardiac and noncardiac pain requires a combination of patient history, ECG, and biomarkers. Overlapping clinical entities in the acute coronary syndrome spectrum of disease allow for similar treatment strategies, and many trials include persons with either unstable angina or non-STEMI.

We have included systematic reviews and randomized controlled trials in a mixed population of persons with unstable angina, non-STEMI, or both, which we will refer to here as acute coronary syndrome.

In the United States, acute coronary syndrome accounts for more than 1. In industrialized countries, the annual incidence of unstable angina is about six out of 10, persons in the general population. Risk factors are the same as for other manifestations of ischemic heart disease—older age, previous atheromatous cardiovascular disease, diabetes, smoking, hypertension, hypercholesterolemia, male sex, and a family history of premature ischemic heart disease.

It can also occur in association with other disorders of circulation, including valvular disease, arrhythmias, and cardiomyopathies. Between 9 and 19 percent of persons with acute coronary syndrome die in the first six months after diagnosis, with about one half of these deaths occurring within 30 days of diagnosis. Several risk factors may indicate poor prognosis and include severity of presentation e. However, several key prognostic indicators associated with adverse outcomes may be used to aid clinical decision making.

Variables, including age 65 years or older, at least three risk factors for coronary artery disease, known significant coronary stenosis, degree of ST segment deviation, recurrent anginal symptoms in 24 hours, use of aspirin in past seven days, and elevated cardiac biomarkers, can be used to generate a scoring system to identify high-risk patients who may experience true ischemic cardiac events and death thrombolysis in MI risk score.

The more of these factors that are present, the greater the likelihood of adverse ischemic events. This helps stratify patients according to risk and identify high-risk patients.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Adapted with permission from Sarkees M, Bavry A. Acute coronary syndrome unstable angina and non-ST elevation MI. Clin Evid Handbook. The medical information contained herein is the most accurate available at the date of publication.