High Risk In Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction

Patients with unstable angina or non-ST elevation myocardial infarction can be at high risk of death or nonfatal myocardial infarction within hours or days of onset of the symptoms.


Patients who have one or more of the following characteristics are at high risk:*

A history of increasing frequency of ischemic symptoms (e.g. chest discomfort, dyspnea) over the preceding 48 hours

Chest discomfort that is ongoing and prolonged (lasting more than 20 minutes) at rest

Pulmonary edema most likely due to ischemia

A new or worsening mitral regurgitation murmur

An S3 gallop

New or worsening rales

Hypotension, bradycardia, tachycardia

Age greater than 75 years

Angina at rest with transient ST segment changes greater than 0.5 mm

A new or presumed new bundle branch block

Sustained ventricular tachycardia

Elevated Troponin T, Troponin I, or CK-MB (e.g. Troponin T or Troponin I greater than 0.1 ng per ml

*From the chart representing short term risk of death or nonfatal MI available in the 2011 AHA Unstable Angina/non-ST elevation myocardial infarction updated guidelines (Table 7, p e442) available at:  https://circ.ahajournals.org/content/123/18/e426.full.pdf.

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