DIAGNOSING AND MANAGING UNSTABLE ANGINA

This Quick Reference Guide for Clinicians contains recommendations on the care of patients with unstable angina based on a combination of ev idence obtained through extensive literature reviews and consensus amo ng members of an expert panel. Principal conclusions include the follo wing. (1) Many patients suspected of having unstable angina can be dis charged home after adequate initial evaluation. (2) Further outpatient evaluation may be scheduled for up to 72 hours after initial presenta tion for patients with clinical symptoms of unstable angina judged at initial evaluation to be at low risk for complications. (3) Patients w ith acute ischemic heart disease judged to be at intermediate or high risk of complications should be hospitalized for careful monitoring of their clinical course. (4) Intravenous thrombolytic therapy should no t be administered to patients without evidence of ST segment elevation and acute myocardial infarction. (5) Assessment of prognosis by nonin vasive testing often aids selection of appropriate therapy. (6) Corona ry angiography is appropriate for patients judged to be at high risk f or cardiac complications or death based on their clinical course or re sults of noninvasive testing. (7) Coronary artery bypass surgery shoul d be recommended for almost all patients with left main disease and ma ny patients with three-vessel disease, especially those with left vent ricular dysfunction. (8) The discharge care plan should include contin ued monitoring of symptoms; appropriate drug therapy, including aspiri n; risk-factor modification; and counseling.