{"id":7506,"date":"2008-11-24T00:41:20","date_gmt":"2008-11-24T00:41:20","guid":{"rendered":"http:\/\/cardiophile.info\/?p=130"},"modified":"2008-11-24T00:41:20","modified_gmt":"2008-11-24T00:41:20","slug":"unstable-angina-risk-stratification","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/unstable-angina-risk-stratification\/","title":{"rendered":"Unstable angina &#8211; risk stratification"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/gmICyGMOxTE\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">Unstable angina &#8211; risk stratification<\/span><\/h2>\n<p>Unstable angina can be classified into low risk, intermediate risk and high risk depending on certain clinical, electrocardiographic and biochemical parameters. The management schedule is different for each risk category.<\/p>\n<p><strong>Low risk unstable angina<\/strong><\/p>\n<p>Features of low risk unstable angina are:<br \/>\nNew-onset exertional angina<br \/>\nMinor chest pain during exercise<br \/>\nPain relieved promptly by nitroglycerine<\/p>\n<p><strong><em>Management f low risk unstable angina<\/em><\/strong><\/p>\n<p>Low risk unstable angina can be managed safely as an outpatient (assuming close follow-up and rapid investigation).<\/p>\n<p><strong>Intermediate risk unstable angina<\/strong><\/p>\n<p>Features of intermediate risk unstable angina are:<br \/>\nProlonged chest pain<br \/>\nDiagnosis of myocardial infarction ruled-out<\/p>\n<p><strong><em>Management of intermediate risk unstable angina<\/em><\/strong><\/p>\n<p>Observe in the emergency room \/ ward<br \/>\nMonitor clinical status and ECG<br \/>\nObtain cardiac enzyme (troponin) every 8 to 12 hours<\/p>\n<p><strong>High risk unstable angina <\/strong><\/p>\n<p>Features of high risk unstable angina are:<br \/>\nRecurrent chest pain<br \/>\nST-segment change<br \/>\nHemodynamic compromise<br \/>\nElevation in cardiac enzyme<\/p>\n<p><strong><em>Management of high risk unstable angina <\/em><\/strong><\/p>\n<p>Monitor in the Coronary Care Unit and consider <a href=\"https:\/\/johnsonfrancis.org\/professional\/early-invasive-treatment-of-unstable-angina-cath-pci\/\">early invasive strategy<\/a>.<\/p>\n<p><strong>Risk stratification of unstable angina by ECG<\/strong><\/p>\n<p>The risk of death or myocardial infarction at 30 days strongly related to ECG during pain:<br \/>\nST depression 10 %<br \/>\nT-wave inversion 5 %<br \/>\nNo ECG changes 1~2 %<\/p>\n<p><strong>TIMI risk score for unstable angina<\/strong><\/p>\n<p>In TIMI risk score for unstable angina, 1 point each is assigned for presence of :<br \/>\nAge more than 65 years<br \/>\nDocumented prior coronary artery stenosis more than 50%<br \/>\nThree or more conventional cardiac risk factors (e.g. age, sex, family history, hyperlipidemia, diabetes, smoking, obesity)<br \/>\nUse of aspirin in the preceding 7 days<br \/>\nTwo or more anginal events in the preceding 24 hours<br \/>\nST-segment deviation (transient elevation or persistent depression)<br \/>\nIncreased cardiac biomarkers<br \/>\nIf the score is between 5 \u2013 7, it comes under the high risk group.<br \/>\nIf the score is between 3 \u2013 4, it comes under the intermediate risk group.<br \/>\nIf the score is 0 \u2013 2, it is low risk unstable angina.<\/p>\n<p><strong>Noninvasive testing in unstable angina<\/strong><\/p>\n<p>Noninvasive testing in unstable angina is recommended for those in intermediate and low risk groups. High risk group needs invasive investigation and management. Noninvasive investigations are used to assess ischemia in patients with a low likelihood of coronary artery disease (CAD) and also to estimate prognosis.<br \/>\nModalities for noninvasive evaluation are:<br \/>\nExercise ECG stress test<br \/>\nExercise test imaging (nuclear)<br \/>\nPharmacological stress test with imaging (nuclear or echo)<br \/>\nChoice of test based on:<br \/>\nResting ECG<br \/>\nAbility of patient to exercise<br \/>\nExpertise\/availability<\/p>\n<p>Noninvasive testing in unstable angina is recommended in low risk patients who are free of chest pain and heart failure for a minimum of 12-24 hours. It is recommended in intermediate risk patients free of chest pain and heart failure for a minimum of 2-3 days. High risk group needs early invasive strategy.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Unstable angina &#8211; risk stratification<\/p>\n","protected":false},"author":1,"featured_media":37991,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-7506","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Unstable angina - risk stratification<\/title>\n<meta name=\"description\" content=\"Unstable angina - risk stratification\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/unstable-angina-risk-stratification\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Unstable angina - risk stratification\" \/>\n<meta property=\"og:description\" content=\"Unstable angina - risk stratification\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/unstable-angina-risk-stratification\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2008-11-24T00:41:20+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/unstable-angina-risk-stratification\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/unstable-angina-risk-stratification\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Unstable angina &#8211; 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