Unstable or worsening angina typically requires inpatient observation.

• A. True
• B. False
• C. Only with MI
• D. Only with ST-elevation

Answer: (A)

Unstable angina represents an acute coronary syndrome with ongoing or escalating ischemia, so the patient is at meaningful risk of progression to myocardial infarction or other deterioration. Because of this risk, inpatient observation is standard practice. In the hospital, clinicians can continuously monitor the heart, perform serial ECGs, and repeat troponin tests to detect any rise that would reclassify the event (for example, from unstable angina to NSTEMI). They can start and adjust anti-ischemic and antithrombotic therapy promptly, and they can risk-stratify the patient to determine whether urgent invasive evaluation, such as coronary angiography, is needed. Even if initial troponin is negative or there is no ST-segment elevation, the patient with unstable or worsening chest pain may still progress to a more dangerous event, so discharge without observation would be unsafe. Thus, unstable or worsening angina typically requires inpatient observation.