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Feature Article

Unstable angina: assessment and management

Jack Federman

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Abstract

An aggressive approach, with early investigation and revascularisation as appropriate, has led to reduced cardiac events and hospital readmissions for patients with unstable angina.

Key Points

  • An early and accurate diagnosis of unstable angina is essential.
  • The underlying pathology is usually an ulcerated plaque, with local platelet aggregation and thrombus, without complete vessel occlusion.
  • ECG changes and a raised troponin level place patients in a high risk group.
  • Management is influenced by the patient’s risk profile.
  • Stress testing may help in diagnosis and directing future management.
  • New medical management to stabilise high risk patients includes low molecular weight heparin, clopidogrel and tirofiban via an infusion.
  • After initial stabilisation, early angiography followed by coronary intervention can significantly improve patient outcomes.
  • Long term risk factor management and drug therapy can control symptoms and reduce future cardiovascular events.

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