Unstable Angina

Pathophysiology

Unstable angina is a form of chest pain that occurs due to blockages in the arteries of the heart. This form of unstable angina is irregular from other types of chest pain. “Unstable angina is a critical phase of coronary heart disease with widely variable symptoms and prognosis” (Hamm & Braunwald, 2000, p. 118). It is a part of the acute coronary syndromes, which affect the heart. Unstable angina occurs when the heart is unable to receive blood flow and oxygen. The condition is very dangerous as it can lead to a heart attack. Individuals with risk factors for unstable angina often have similarities to other heart conditions such as cardiomyopathy.

Presentation

Individuals with unstable angina will feel chest pain that occurs in other parts of the body such as the arms, shoulders or neck. They will most often have shortness of breath and discomfort that will feel like tightness in the chest. The pain does not go away with rest and does not improve with medication. The pain will also increase with frequency over time. The pain caused by unstable angina will last for longer than twenty minutes and is not caused by any particular physical exertion. Once these symptoms are observed a doctor would complete a physical examination as well as taking the patient’s blood pressure. Abnormal heartbeats may be an indicator of unstable angina. Further testing in the form of blood tests, EKG or stress tests could accurately diagnose the condition and also guide the treatment to treat the symptoms of unstable angina.

Population

Unstable angina typically occurs in individuals over the age of 55. As an individual gets older their chances of getting the condition increase. There are also numerous other risk factors for unstable angina. These risk factors include a family genogram history of heart disease, smoking, diabetes, obesity, and stressors. Men are at an increased risk over women of being diagnosed with unstable angina. Unhealthy lifestyles of poor dietary habits as well as an inactive lifestyle also contribute to the risk of becoming diagnosed with any coronary syndrome and is especially in the case of unstable angina. 

Patient Management

Medication is often the main course of treatment for individuals who suffer from unstable anginas. Blood thinners, as well as aspirin, may be prescribed to patients to not only relieve the pain but also to prevent angina from occurring. Medications may also be prescribed to address any associated features of angina such as high blood pressure. Surgery may also be performed on individuals who are unable to be treated by medication. Heart bypass surgery can be done to fix the arteries that are blocked so that an individual no longer suffers from the condition. Once an individual is released from the hospital they should follow the discharge plan. “The discharge care plan should include continued monitoring of symptoms; appropriate drug therapy, including aspirin; risk-factor modification; and counseling” (Braunwald et al., 1994, p. 613). Through following this plan the individual can prevent further incidences of unstable anginas from occurring.

Prognosis

The prognosis of individuals who have unstable anginas is positive if they are given the right treatments and they make the appropriate lifestyle changes. However, the condition can indicate that there are serious problems with the heart. If left unresolved the individual may be at risk for suffering a heart attack and possibly dying. The prognosis for the individual is dependent on how severe the condition has progressed and what treatment options are available to them. Multiple incidents of heart attacks and unstable anginas can lead to decreased chances of a positive outcome. 

References

Braunwald, E., Jones, R. H., Mark, D. B., Brown, J., Brown, L., Cheitlin, M. D., ... & Fuster, V. (1994). Diagnosing and managing unstable angina. Agency for Health Care Policy and Research. Circulation, 90(1), 613-622.

Hamm, C. W., & Braunwald, E. (2000). A classification of unstable angina revisited. Circulation, 102(1), 118-122.