Unstable Angina

Unstable angina is an acute coronary syndrome caused by myocardial ischemia without enough myocardial necrosis to meet the diagnostic criteria for myocardial infarction. It may result from a disrupted plaque with a platelet-rich, non-occlusive thrombus, coronary vasospasm, or a supply-demand imbalance. The bedside challenge is not to reassure yourself when pain settles. Ischemia can recur, the thrombus can progress, and an initial ECG or troponin result may be nondiagnostic. The RN’s priorities are rapid ECG and serial hs-cTn assessment, recognition of instability, safe administration of antithrombotic and anti-ischemic therapy, and timely escalation.