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