Overview

• Myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis
• Risk Factors → diabetes, hyperlipidaemia, hypertension, obesity, metabolic syndrome, renal impairment, PVD, obesity, advanced age, smoking

Making Diagnosis

Clinical Features:

• Chest Pain → comes on randomly
• Sweating
• Dyspnoea
• Syncope

Investigations:

• ECG → typically no changes
• Troponin → not elevated

Management Plan

• 1st Line → Aspirin 300mg (and conitnue indefinitely) ****+ Fondaparinux (antithrombin - if no immediate PCI planned)
• Calculate GRACE (estimated 6 month mortality)
  • Low Risk (6 month mortality ≤3%) ****→ ticagrelor + aspirin
  • Intermediate/High Risk (6 month mortality >3%) → angiography with followup PCI if indicated. Give ticagrelor.