Low-risk patients who arrive at a medical facility in a pain-free state, have an unchanged or normal electrocardiogram and are hemodynamically stable can usually be managed as an outpatient. Intermediate- and high-risk patients should be admitted and placed on bed rest with continuous electrocardiographic monitoring. All patients should receive regular aspirin (160 to 324 mg) and intravenous heparin as soon as possible. If angina is still present and there are no contra-indications, beta blockers and nitroglycerin should be administered. Low molecular weight heparins and platelet glycoprotein IIb/IIIa receptor antagonists are exciting new classes of drugs which may markedly change our current clinical practice. Low molecular weight heparins appear at least as good, if not better than unfractionated heparin, and are easier to administer. The addition of glycoprotein IIb/IIIa inhibitors to heparin and aspirin also appears to decrease clinical end-points. In addition, they have markedly improved the safety and efficacy of PTCA in patients with unstable angina. An early invasive strategy seems warranted in high-risk patients with unstable angina. Catheterization is also indicated in patients who fail medical therapy or have a positive stress test. In intermediate-risk patients, the choice of early conservative or early invasive strategies depends upon physician experience and patient preference. Finally, all patients should receive intensive counseling on risk factor modification. Most patients should continue long-term aspirin, beta blockers, and a 'statin' drug. ACE inhibitors are indicated in patients with LV dysfunction.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine