Unstable angina. An approach to management

Unstable angina is an increasingly important medical problem. Initial assessment includes whether the pain is likely to be cardiac in origin, a risk stratification based upon the nature of the chest pain, and assessment of any haemodynamic changes or electrocardiographic changes (although this may be normal). After pain relief and aspirin administration, patients with prolonged rest pain should be referred immediately to hospital. Hospital management involves anti ischaemic therapy and then a decision as to whether coronary angiography or non-invasive testing is the initial investigation. The risk of myocardial infarction and death is highest in the first 4-6 weeks. Depending on clinical progress and angiographic findings, patients may continue medical therapy or have revascularisation by bypass surgery or coronary angioplasty.