Unstable angina. Approaching treatment with a rational plan

An appreciation of the pathogenesis of unstable angina forms the basis of rational therapy. The physician's task is to quickly reduce inappropriate myocardial oxygen demands, find and treat factors causing these increased demands, increase coronary blood flow, and prevent progressive thrombosis. Once the patient is stabilized, the physician can assess the risk of myocardial infarction. High-risk patients may benefit from percutaneous transluminal coronary angioplasty or coronary bypass surgery. The question is how to best accommodate accompanying factors (eg, associated health disorders, advanced age), not whether drug therapy, interventional therapy, or coronary bypass surgery is the best method. All three methods are, at different times, necessary for optimal management of unstable angina.