ln stable angina-
Ref R Alagappan - Manual of Practical Medicine 4th Edition -page no 180 Unstable Angina It is due to dynamic obstruction of coronary aery - spasm and or rupture of plaque. It is defined as angina pectoris or equivalent ischaemic discomfo with either one feature. 1. It occurs at rest or with minimal exeion usually lasting > 10 minutes. 2. It is severe and of new onset within the prior 4-6 weeks. 3. It has a crescendo pattern of pain - distinctly severe, prolonged and more frequent than before. Unstable angina is distinguished from non-STelevation myocardial infarction by the absence of elevated serological markers of myocardial necrosis. It is also distinguished from ST-elevation MI by the absence of persistent ST segment elevation. Pathogenesis 1. Plaque rupture or erosion with superimposed nonocclusive thrombus (most common) 2. Progressive mechanical obstruction - either rapidly advancing coronary atherosclerosis or restenosis following percutaneous coronary intervention. 3. Increased discrepancy between myocardial oxygen demand and supply. Management Immediately assess the following: * Clinical evaluation - history and physical examination * 12 - lead ECG recording * Measurement of cardiac specific markers - troponin and CK-MB. All ACS patients should be placed on aspirin, b-blocker, nitrate and clopidogrel immediately. Low risk patients - On observation if the patient remains pain-free with normal ECG and normal levels of cardiac markers, submit them for stress ECG. If the stress test is negative, consider alternative diagnosis. If the stress test is positive, continue medication and invasive testing when required. Intermediate and high risk patients - Patient has to be admitted in the intensive care unit and to be managed with anti-ischaemia, antiplatelet and anticoagulant group of drugs. In the meantime coronary angiography is planned.
CK-MB is elevated
Troponin I is elevated
Myoglobin is elevated
The levels of cardiac marker remainUNCHANGED
C.V.S