Feature Article

Unstable angina: assessment and management

Jack Federman



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.