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Acute Coronary Syndrome: Angina, Emergency Medicine

Reviewed 06/2017



  • Chest discomfort, due to imbalance of myocardial blood supply and oxygen requirements

  • Canadian Cardiovascular Society classification for angina:

    • Class I: No angina with ordinary physic...


Signs and Symptoms


  • Chest pain:

    • Substernal pressure, heaviness, tightness, burning or squeezing

    • Radiates to neck, jaw, left shoulder, or arm

  • Poorly localized, visceral pain

  • Anginal equivale...



  • IV access

  • Aspirin

  • Oxygen

  • Vital signs and oxygen saturation

  • Cardiac monitoring

  • 12-lead ECG, if possible

  • Sublingual nitroglycerin

Initial Stabilization/Therapy

  • IV access

  • Oxygen

  • Cardiac monit...



Admission Criteria

  • Patients with UA require admission to the hospital

  • Early intervention with cardiac catheterization likely decreases mortality in patients with elevations in cardi...

Pearls and Pitfalls

  • History is the most important factor in differentiating unstable from stable angina or noncardiac pain

  • All patients with chest pain or symptoms concerning for a cardiac etiology sho...

Additional Reading

  • 2012 Writing Committee Members, Jneid  H, Anderson  JL, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myo...



  • 411.1 Intermediate coronary syndrome

  • 413.1 Prinzmetal angina

  • 413.9 Other and unspecified angina pectoris


  • I20.0 Unstable angina

  • I20.1 Angina pectoris with documented spasm

  • I20.9 Angina pector...

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