Fast Five Quiz: Angina

Yasmine S. Ali, MD


August 27, 2021

Unstable angina differs from stable angina in that the discomfort is usually more intense and easily provoked, and ST-segment depression or elevation on ECG may occur. Otherwise, the manifestations of unstable angina are similar to those of other conditions of myocardial ischemia, such as chronic stable angina and myocardial infarction (MI).

Important associated symptoms include dyspnea, generalized fatigue, diaphoresis, nausea and vomiting, flu-like symptoms, and, less commonly, lightheadedness or abdominal pain. The intensity of pain on a 1-10 scale does not correlate with diagnosis or prognosis. Older patients and female patients are more likely to have atypical signs and symptoms.

A large area of myocardial jeopardy may manifest as signs of transient myocardial dysfunction and typically signifies a higher risk situation. Such signs include:

  • Systolic blood pressure < 100 mm Hg or overt hypotension

  • Elevated jugular venous pressure

  • Dyskinetic apex beat

  • Reverse splitting of the second heart sound

  • Presence of a third or fourth heart sound

  • New or worsening apical systolic murmur due to papillary muscle dysfunction

  • Rales or crackles

Read more on the presentation of unstable angina.


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