[Unstable angina--diagnostic methods]

The means available to the physician to secure diagnosis, to define risks and to decide on optimal treatment are reviewed. The history, the physical findings on admission and an electrocardiogram at rest form the essential basis for a first appreciation. Then follow non invasive investigations i.e. ergometry, myocardial radionuclide scan and a continuous ECG recording for 24 hours. These studies provide a good risk assessment. On the basis of the clinical assessment and the additional studies the necessity for a coronary angiography can be decided on in most instances. Coronary angiography is required prior to any percutaneous or surgical cardiac intervention. It has the disadvantage to be invasive and it requires a complex infrastructure. However, it has also become a safe procedure and it provides optimal risk assessment.