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 Unstable Angina  

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Can someone please summarize the unstable angina case for CCS, i am confused on the steps



let's construct a case..

A 65 year old male comes to ER with chest pain.

Vitals- BP-130/70, rr- 30/min, temp- 98 F, pulse 110/min.

Patient cannot give much history as he is short of breath and in severe pain.



ORDER: O2, IV access, EKG stat


I would also order :

vitals every one hour,

NTG sublingual stat


your ekg will come in 2 min..

So I will do a brief physical exam meanwhile, do atleast chest/lungs... can anyone add or direct the case furthur?


After brief examinaton, EKG result will be available.. say examination is normal and EKG shows 3 mm ST depression and T wave inversion in leads II, III and AVF..

What's next?

( question: in UW cases: they mentioned HEENT/neck, Rectal,Abdomen and musculoskeletal ex.,

how important are these to perform in this case?)


So our differential is:- MI, UAngina, PE, Pneumonia, Peptic ulcer,

LOCATION: I assume he is in the ER.

Order: Troponins, CXR, cbc, cmp, amylase/lipase?, PT/PTT,

Rx: I think Aspirin can be started earlier, when Should we start heparin?

Any further inputs before we advance the clock?


#we can start aspirin if we don't suspect Aortic here, we can

#you will start heparin when STEMI is confirmed on EKG, and you can arrange for cath (meaning you are not planning tpa, and no contraindications to heparin.), OR NSTEMI is a possibility.

this patient could have unstable angina or NSTEMI.

SO while awaiting troponins, we order:

aspirin, ntg , heparin, atorvastatin, metoprolol- meaning, we will assume it to be mi unless proven otherwise, and treat to reduce mortality...

Take interval history- if pain has reduced etc..

Suppose short p/e showed normal JVD, and examination.. PT is in severe distress, the pain still remains.

We will get cxr before troponins.. SO look for pulmonary edema.

CXR is normal

bmp is normal

cbc normal

troponins are negative.


Edited by milee99 on Apr 10, 2009 - 3:20 AM


hi, management for NSTEMI or unstable angina is same..

Look for the algorithm in above link.


I'd heard that the same mamagement isn't effective


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