Unstable angina: Current recommendations and new directions

A. J. Solomon, Jeffrey Breall, B. J. Gersh

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)18-23
Number of pages6
JournalACC Current Journal Review
Volume7
Issue number3
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Unstable Angina
Aspirin
Heparin
Platelet Glycoprotein GPIIb-IIIa Complex
Low Molecular Weight Heparin
Direction compound
Integrin beta3
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Bed Rest
Patient Preference
Nitroglycerin
Exercise Test
Angiotensin-Converting Enzyme Inhibitors
Catheterization
Pharmaceutical Preparations
Counseling
Electrocardiography
Outpatients
Physicians
Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Unstable angina : Current recommendations and new directions. / Solomon, A. J.; Breall, Jeffrey; Gersh, B. J.

In: ACC Current Journal Review, Vol. 7, No. 3, 1998, p. 18-23.

Research output: Contribution to journalArticle

Solomon, A. J. ; Breall, Jeffrey ; Gersh, B. J. / Unstable angina : Current recommendations and new directions. In: ACC Current Journal Review. 1998 ; Vol. 7, No. 3. pp. 18-23.
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