30th May 2026

Diagnosis

Investigations

• ECG: A 12-lead ECG should be performed within 10 minutes to identify changes such as ST depression, transient ST elevation, or T-wave inversion.
• Troponin: Troponin levels help differentiate UA from NSTEMI. Dynamic or persistently normal troponin levels can rule out myocardial infarction. If there is strong suspicion of unstable angina with negative ECG and troponin, serial measurements are essential to identify progression to NSTEMI and to help with risk stratification. 
• Chest X-ray: To rule out alternative diagnoses like pneumothorax or aortic dissection.
• Blood Tests: FBC, U&E, LFTs, glucose, and CRP to assess the patient’s overall health and detect complications.
• Echocardiography: Used to evaluate left ventricular (LV) function and identify regional wall motion abnormalities suggestive of ongoing ischemia.
• Risk Pathways: Troponin levels, clinical features, and ECG findings guide decisions regarding further testing and intervention, including coronary angiography.

Clinical Manifestations

Chest pain in UA is typically retrosternal, lasting for more than 20 minutes, and often occurs at rest or with minimal exertion. Symptoms are frequently accompanied by nausea, sweating, breathlessness, or dizziness.

• Red Flags: Hemodynamic instability, acute LV failure, or arrhythmias.