What is unstable angina and how is it treated?

Angina pectoris refers to chest pain originating from the heart specifically due to ischemic heart disease, which occurs when coronary arteries narrow from atherosclerosis. Atherosclerosis is the process by which deposits of cholesterol accumulate in an artery. These deposits of cholesterol, or plaques, can burst, causing a blood clot to develop on the plaque.

When clots grow and block coronary arteries, the heart is unable to get enough oxygen from the blood to meet an increased need for oxygen, such as during physical effort. Consequently, individuals experience chest pain.

Patients describe the pain in many different ways. Some recall the pain as tightness, heaviness, squeezing, or pressure of the chest. Others describe the pain as burning, aching, or suffocating. Angina pain usually begins in the chest. However, this pain may spread out to the jaw, neck, shoulder, or arm.

Angina falls into two categories: Stable or unstable. Stable angina is a chronic condition characterized by an unchanged pattern for at least 60 days. Stable angina occurs during increased physical exertion or by stress and responds to medication, such as nitroglycerin given under the tongue (sublingual administration). With stable angina, coronary artery blockages tend to be fixed or stable, meaning the blockages are not as susceptible to disruption.

Unstable angina, by contrast, is an acute condition with a changing pattern of occurrence, severity, and/or frequency. Individuals with unstable angina include:

those with no previous angina, for whom onset is severe and/or frequent,
those with previously stable angina whose angina is worsening (occurs more often, lasts for longer periods, happens with less physical effort than before, or requires more medication to control an episode), or
those with angina occurring at rest.

With unstable angina, coronary artery blockages are not as fixed and are more susceptible to disturbance. An episode suggests that a blockage has been disrupted, triggering a coronary artery to become partly or completely closed.

During an episode of unstable angina, individuals should seek immediate medical attention. If not treated, it can lead to serious injury to the heart or the patient may suffer a heart attack.

Physicians manage angina with either medication, to reduce the heart’s oxygen needs, or an intervention, to boost the heart’s oxygen supply. Typically, individuals experiencing an episode of unstable angina are treated in-patient at a hospital. Upon admission, patients rest and receive medications. One of these medications is antiplatelet therapy, which prevents blood from clotting to keep a clot from forming in the coronary artery wall.

Aspirin and clopidogrel are popular anti-platelet medications, given separately or together. Using these drugs may prevent a heart attack. Heparin and nitroglycerin, given either under the tongue or intravenously, are also used. Doctors may use other drugs as well. These include beta-blockers, calcium channel blockers, and medications to control anxiety, blood pressure, and irregular heartbeats.

Most patients improve with rest and medication during the first 48 hours upon admission. For patients who do not improve, cardiac catheterization and surgical intervention may be necessary. This can include coronary artery bypass grafting (CABG) or balloon angioplasty (PTCA) with or without stenting.

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