UNSTABLE ANGINA - PHARMACEUTICAL VERSUS INVASIVE THERAPY

Patients with chest pain that persists for more than 20 minutes and is refractory to sublingual nitroglycerin should be placed at bed rest i n a coronary or an intensive care unit with continuous electrocardiogr aphic monitoring. Treatment with nitroglycerin, a beta blocker, hepari n infusion, and aspirin should be initiated if there are no contraindi cations, although some patients' pain may be refractory to maximum dos es of these drugs. In a patient receiving a beta blocker, there may be a role for adding nifedipine.57 If calcium antagonists am given witho ut beta blockers, the risk of myocardial infarction and death is incre ased. Thrombolytic therapy is of no value for unstable angina. For pat ients who continue to have symptoms, a more invasive approach, such as intraaortic balloon counterpulsation, diagnostic coronary arteriograp hy, angioplasty, or coronary artery bypass grafting, may be necessary. According to available data, angioplasty and coronary artery bypass s urgery should be delayed until the patient's condition is stable. Aspi rin and a beta blocker should be administered on a long-term basis to patients with good left ventricular function.15 Anticoagulation for 3 months may be appropriate for high-risk patients.45