• Unstable angina and myocardial infarction are different

clinical presentations that result from a common underlying

pathophysiological mechanism

• Due to an acute or subacute primary reduction of

myocardial oxygen supply, provoked by disruption of an

atherosclerotic plaque associated with thrombosis,

i i i i i

•Age and male sex are associated with more severe

CAD and consequently with an increased risk of an

unfavorable outcome

•Previous history of coronary artery disease, diabetes

mellitus, hypertension and smoking are well known risk

factors of CAD and indicate a worse prognosis

•Is most often normal in acute coronary syndromes

•The purpose is to exclude non-cardiac and non-ischaemic

causes of chest pain, to look for signs of potential

haemodynamic instability and left ventricular dysfunction

•ST segment shifts and T wave changes are the most reliable ECG indicators of unstable angina

•Significant Q waves are consistent with previous MI but do not imply current instability

• Cardiac troponin T and I are the preferred markers of myocardial necrosis and are more specific and reliable than CK and CKMB

• In our setting only CK is available.

• Should be done on admission and 6-12 hrs later

•Anti-ischaemic agents decrease myocardial oxygen utilization (decreasing heart rate, lowering blood pressure or depressing left ventricular contractility) or inducevasodilation

• Low molecular wt heparin

• B-blockers

• Nitrates

• Ca channel blockers

• Unfractionated heparin

Antiplatelet agents:

1. asprin

2. adenosine diphosphate receptor antagonists

3. glycoprotein IIb/IIIa antagonists

• Patients have to be observed for chest pain and haemodynamic instability and have continuous multilead ECG monitoring

• After stabilization and before discharge, a stress test is useful to confirm the diagnosis of CAD and to predict medium and long term risk for subsequent coronary events

• Aggressive and extensive risk factor modification is warranted in all patients

• Quit smoking and lipid lowering therapy

• ACE-inhibitors

• B-blockers

• Asprin

• Persistently elevated cardiac enzymes

• Recurrent ischaemia

• Haemodynamic or rhythmic instability

• Early post MI unstable angina

• Provides information on the presence and severity of CAD

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Risk Factors

Physical ExaminationECG

Lab Assessment

Treatment

Stress ECG

Coronary Angiography

Dm Ht Smk M Hf ECG Ck Ck H/F Asa Ca/

BB

Nt Ace Stat SE CA