…and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute…

…risk score for NSTEMI and unstable angina [calc_timi_nstemi] TIMI SCORE 30 days mortality 30 days acute MI Probability of revascularization 0 1 1…

…majority occur within the first hour(s). Hence, the majority of all fatal cases of NSTEMI and unstable angina occur during the first hour(s)…

…or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI)…

…epidermal necrolysis, DRESS syndrome) have been rarely reported with acetylsalicylic acid. Discontinue acetylsalicylic acid at the first sign of skin rash, mucosal lesions, or hypersensitivity…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…not delay cardioversion in an unstable patient. Rate control in the stable patient Drug Situation Comment : : : Beta blocker (metoprolol) First choice in most cases The…

…Unstable Yes Often raised Reperfusion, intensive care Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of…

ECG Introduction The traditional classification of acute coronary syndromes (ACS) into ST segment elevation myocardial infarction (STEMI), non STEMI (NSTEMI), and unstable angina (UA) has…

…is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS), including: Unstable angina (UA) Non ST elevation myocardial infarction…

…a high probability of unstable angina (UA), and patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST…

…classified into unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). While the incidence of STEMI is…

…reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of an intraluminal thrombus. The clinical spectrum includes unstable angina…

…is the most severe complication of coronary artery disease. The most common initiating mechanism is rupture or erosion of a vulnerable (unstable) atherosclerotic coronary plaque…

…indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure…

…dislocation. Immobilisation of a ligament injury, a tendon injury, or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture…

…no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal jugular vein is the first choice in most situations…

…Gufoni manoeuvre for treatment. Contraindications Absolute: Unstable cervical spine injury, recent cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis…

…a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or marked electrolyte disturbance; correct these first before elective…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known…

…in chest trauma and postoperatively. Emergency needle decompression: a clinical suspicion of tension pneumothorax in a haemodynamically or respiratorily unstable patient. Contraindications In tension pneumothorax…

…coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or…

…monitoring Use a balanced crystalloid in the first instance. Give small boluses, for example 250 to 500 mL, with immediate reassessment of the blood pressure…

…otherwise haemodynamically unstable. The benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of clonidine…

…history of bleeding, unstable anticoagulation control, advanced age, and the use of certain medications or alcohol. Interpretation of HAS BLED score A score of 0…

…for treatment of infarcting myocardium early II trial substudy. Circulation. 2000 Oct 24;102(17):2031 7. The TIMI risk score for unstable angina/non…

…whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or…

…unstable angina and stroke—may occur abruptly and without preceding warning. Initiation and progression of the fatty streak The earliest visible lesion is the fatty…

…the patient is clinically unstable, identify life threatening diagnoses rapidly, and select a safe disposition and diagnostic strategy. Only a minority of patients presenting with…

…denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction…

…life threatening causes of chest pain: Ischemic heart disease : stable angina pectoris, unstable angina pectoris, acute myocardial infarction (AMI). Note that unstable angina pectoris and…

…unstable angina) has increased, resulting in fewer cardiac arrests caused by these conditions ( Jerkeman et al ). It is often difficult to determine the cause of…

…and unstable angina have similar pathophysiology and management are also similar. Hence, the difference between STE ACS and NSTE ACS is merely the presence of…

…supervision of their clinician. Indeed, kinesiophobia (fear of exercising) is common after myocardial infarction and it is associated with poorer survival. Patients with unstable angina…

…low to moderate risk of CAD. In patients with a high to very high risk of CAD, invasive coronary angiography is the first line option…

…arrhythmias. Unstable angina pectoris in the acute phase (before stabilization of symptoms) – due to the risk of developing acute myocardial infarction and inducing ventricular arrhythmias…

…decreases and vice versa. The physiological purpose of this phenomenon is to allow for faster cardiac cycles during tachycardia (e.g during physical exertion). Therefore…

…occur in both NSTE ACS (NSTEMI and unstable angina pectoris) and STE ACS (STEM). However, the significance of the ST segment depression differs markedly in…

…compared to those with Non ST Elevation Myocardial Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater extent of ischemia present in STEMI…

…wide complex tachycardia (WCT), the acute management of both stable and unstable presentations, the critical entity of electrical storm, and the long term management strategies…

…is available; in VF/VT only after the 3rd defibrillation 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL), maximum 1…

…or gastric surgery Gastric lavage Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning…

…and stabilise the patient Immediate assessment 1. Assess airway, breathing, circulation and level of consciousness. 2. Attach ECG, pulse oximetry and repeated blood pressure measurement…

…Penetrating torso injury with shock. A positive FAST scan in an unstable trauma patient. An unstable pelvic fracture with circulatory compromise. A ruptured aortic aneurysm…

…unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose During ongoing opioid treatment: a breakthrough dose of…

…Follow up of known HPA suppression to determine whether replacement can be stopped. The test is not the first line investigation in a suspected acute…

…is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable…

…strategy. In haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as potential causes of shock…

…from injured cardiomyocytes at substantially lower concentrations than earlier generation assays. They can identify troponin concentrations in approximately 50–95% of healthy individuals, whereas sensitive…

…ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At first medical contact, assessment should occur concurrently with acquisition of the initial ECG…

…carotid, vertebral and coronary arteries. In one study cited in the source material, FMD was identified in 86% of patients with SCAD. SCAD should therefore…

…coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological stress. The physiological basis is an…

…emphasizing concurrent rapid rewarming of the patient. Consider extracorporeal membrane oxygenation (ECMO) in unstable patients. The administration of medications (such as amiodarone and epinephrine) and…

…unstable angina) at any time during the disease course. Some patients may experience an acute coronary syndrome as the first manifestation of their coronary artery…

…unstable angina) at any time during the disease course. Some patients may experience an acute coronary syndrome as the first manifestation of their coronary artery…

…and the instructions decide whether the investigation will be usable. Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended before treatment is…

…involvement. Work up of unexplained iron, B12 or folate deficiency when blood tests are insufficient. Contraindications Severe coagulopathy or ongoing anticoagulation — correct this first . Thrombocytopenia…