Which factors indicate a high risk of acute coronary syndrome (ACS) in unstable angina?

Updated: Oct 01, 2020
  • Author: Walter Tan, MD, MS; Chief Editor: Eric H Yang, MD  more...
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Estimation of the likelihood of acute coronary syndrome (ACS) is a complex, multivariable problem that cannot be fully specified in the list below, which is meant more to illustrate major relations than to offer rigid algorithms. A high likelihood of ACS includes any of the following features:

  • History of previous MI, sudden death, or other known history of CAD

  • Chest, neck, jaw, or left arm pain consistent with prior documented angina

  • Transient hemodynamic or ECG changes during pain

  • ST-segment elevation or depression of 1 mm or more

  • Marked symmetrical T-wave inversion in multiple precordial leads

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