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[Nitrates in unstable angina]

L Figueiredo1

  • 1Serviço de Cardiologia, Hospital de Santa Marta, Lisboa.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|March 1, 1993
PubMed
Summary

Unstable angina, a critical heart condition, requires aggressive treatment including nitrates and aspirin to prevent heart attack. Early revascularization via angioplasty or surgery may be necessary for severe cases.

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Area of Science:

  • Cardiology
  • Internal Medicine

Context:

  • Unstable angina is an acute coronary syndrome.
  • It presents distinct clinical and laboratory features compared to stable angina and myocardial infarction.
  • Pathologically, it involves plaque rupture, thrombus formation, and coronary artery occlusion.

Purpose:

  • To outline the clinical presentation and pathological mechanisms of unstable angina.
  • To discuss current therapeutic strategies, including medical management and revascularization procedures.
  • To highlight the risks and benefits associated with different treatment modalities.

Summary:

  • Patients with unstable angina face a high risk of myocardial infarction and death.
  • Aggressive therapy in an Intensive Coronary Care Unit is crucial, involving beta-blockers, calcium antagonists, nitrates, and aspirin.
  • Heparin and thrombolytic therapy remain subjects of debate, though heparin is common in acute phases.
  • Coronary angiography guides further management with percutaneous transluminal coronary angioplasty (PTCA) or coronary bypass surgery for refractory cases.

Impact:

  • Aspirin significantly reduces the risk of death and myocardial infarction.
  • Early revascularization through PTCA or bypass surgery can be beneficial, particularly in selected patients.
  • PTCA, despite a higher complication rate than elective procedures, reduces late infarction and death in cases with initial success.
  • Surgical revascularization improves outcomes and survival in patients with reduced left ventricular function.

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