Unstable Angina still exists. It can be missed especially high sensitivity troponin is not used. Sometimes you can catch it on the ECG.

A 50-something woman with H/o HTN, ESRD, CAD S/p complex PCI to ostial LAD and ramus (10/2020) and CABG x3 (LIMA to LAD, SVG to OM, SVG to ramus)She complained of intermittent episodes of substernal chest pain, radiating to left shoulder, lasting 2-3 minutes.This had been worked up before at another ED on 3 occasions for the same chest discomfort.--The 1st time, she was " ruled out " with a point of care (POC) troponin ＜0.03 ng/mL.--The 2nd time, she was " ruled out " again with a POC troponin ＜0.03 ng/mL.--The 3rd time, she " ruled out " with a laboratory-based 4th generation troponin at 0.018 ng/mL (Abbott Architect, LoD = 0.010 ng/mL, URL = 0.030 ng/mL)Advice:Do NOT use the point of care troponins that are on the market now.(Excellent high sensitivity point-of-care troponins are are coming soon).Advice #2:Use high sensitivity troponin (NOT 4th generation troponin).  Any troponin using units of ng/mL or mcg/L is a 4th generation (NOT a high sensitivity 5th generation).  Aside:" High sensitivity " mostly means " high precision " .  The value obtained is very accurate even at VERY low levels.  This is represented by the " coefficient of variation " (a measure of the reproducibility of results obtained from measuring the same sample many times); a CV of 10% at a very low level is good.  For high sensitivity, the CV should be 10% at a level substantially lower than the 99% URL.Initial ECG, without pain, with K = 5.9 (K level...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs