Fast Five Quiz: Angina

Yasmine S. Ali, MD


August 27, 2021

Absolute elevations of high-sensitivity troponin and/or cardiac enzymes such as creatine kinase and its MB isoenzyme are highly specific evidence of myocardial cell death and distinguish NSTEMI from unstable angina. Biomarkers alone or as part of accelerated diagnostic protocols may reduce the number of patients with a missed diagnosis of NSTEMI who are at increased risk for major adverse cardiac events.

Elevated BNP levels have been linked to more significant coronary artery lesions in patients with unstable angina, including patients with greater left anterior descending artery involvement. Although determining BNP levels may add incremental information to the assessment of patients with unstable angina, it should be used in context with other cardiac markers to guide medical decision-making.

Ambulatory ECG monitoring can be used for diagnostic purposes in patients with chest pain suggestive of variant angina but is primarily used to evaluate the frequency of silent ischemia. Silent ischemia has been shown to be an independent predictor of mortality in patients with angina pectoris.

ECG is useful for evaluating patients with angina; however, findings vary. Transient ST-segment elevation is a characteristic finding in patients with variant angina; however, it may only be present during symptomatic episodes and typically resolves completely within minutes. In more severe cases, ST elevation may be followed by T-wave inversions for hours to days.

Read more on the workup of patients with suspected unstable angina.


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