Snapshot A 70-year-old man presents to his primary care physician with recurrent, intermittent, sudden-onset chest pain and shortness of breath. He reports that he often tires easily climbing the stairs. Initially, he experienced chest pain with activity, but now it occurs throughout the day. Medical history is significant for hypertension and type II diabetes. An electrocardiogram demonstrates mild ST-segment depressions in V1-V2. Cardiac troponins are not elevated. (Unstable angina) Introduction Clinical definition login to view 2 more bullets Types of AnginaTypesPathologyClinical PresentationCommentsStable anginaTypically secondary to atherosclerosisthis impairs coronary perfusion in the setting of increased cardiac demand (e.g., exertion)Chest pain that develops with exertion but relieves with rest or nitroglycerinElectrocardiogrammay demonstrate ST segment depressionsUnstable anginaIncomplete coronary artery occlusion by a thrombusindicative of a ruptured plaque with subsequent clot formationChest pain that persists whether with decreasing physical activity or restElectrocardiogrammay demonstrate ST segment depressions or T wave inversionsPrinzmetal anginaCoronary artery spasmsChest discomfort unrelated to physical activity and is episodicTriggerscocainealcoholtriptansElectrocardiogramappears similar to a STEMImay demonstrate ST segment elevations with reciprocal ST depressionsTreatmentcalcium channel blockerssmoking cessationnitrates Epidemiology Risk factors login to view 3 more bullets Etiology Pathogenesis login to view 19 more bullets Imaging Initial login to view 3 more bullets Cardiac catheterization for definitive diagnosis for high-risk patients login to view 1 more bullet Low risk patients with negative work-up can be discharged with reassurance login to view 1 more bullet Studies Stress-testing login to view 7 more bullets