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NSTEMI
0%
0/2
Stable angina
50%
1/2
STEMI
Unstable angina
Variant angina
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This patient is presenting with a worsening/change in his underlying chest pain suggesting a diagnosis of unstable angina. The spectrum of acute coronary syndrome depends on the patient's symptoms and diagnostic tests. Unstable angina is defined as chest pain that is exertional and meets any of the following criteria: 1. Increased chest pain with exertion 2. Change in the quality of chest pain 3. Chest pain with less exertion than previous pain Essentially, any change in a patient's symptoms or chest pain from a history of stable angina classifies it as unstable angina. The management of unstable angina involves administration of beta-blockers, aspirin, statins, ACE inhibitors, and a diagnostic catheterization to see if further intervention is needed. Incorrect Answers: Answer 1: NSTEMI presents with chest pain, a normal ECG (or an ECG without ST-segment elevation), and an elevation in cardiac troponins. Though this patient's troponin is elevated, in the setting of chronic kidney disease and no change from his baseline troponin, this would not be considered an acute elevation in troponin. Answer 2: Stable angina is chest pain upon exertion that resolves upon resting. This patient's chest pain has changed and he now has chest pain with even minor exertion thus classifying it as unstable angina. Answer 3: STEMI presents with crushing substernal chest pain, ST elevation on ECG, and an elevation in troponins. Answer 5: Variant angina or Prinzmetal angina presents with chest pain typically in a young woman with a smoking history that typically occurs at night secondary to vasospasm. During episodes of vasospasm, the patient will have intense chest pain and possible ST elevation on ECG. Bullet Summary: Unstable angina is chest pain that occurs at rest or any change in the patient's underlying stable angina.
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