TREATMENT OF ISCHEMIC-HEART-DISEASE - ROLE OF DRUGS, SURGERY AND ANGIOPLASTY IN UNSTABLE ANGINA PATIENTS

The ten unstable angina should only be used to describe patients whose immediate prognosis is uncertain and the nature of the unstable disea se may vary on a patient to patient basis, making broad categorization of such patients inappropriate. Unstable angina may be caused by extr acardiac factors, such as uncontrolled hypertension and tachycardia, d isruption of an atheromatous plaque, dynamic or intermittent coronary artery thrombosis, haemorrhagic dissection into an atheromatous plaque , epicardial coronary spasm or progression of atherosclerosis as a res ult of plaque healing. Control of symptoms using medical therapy with a combination of nitrates, beta-blockers and calcium antagonists is us ually quite successful. In the absence of contra-indications, intraven ous heparin, and possibly anti-platelet agents, should also be used in the acute phase of treatment. In addition, one aspirin a day is indic ated unless there are definite contra-indications. If symptoms are rel ieved, evaluation and management should proceed as with chronic stable angina. Identification of patients with a poor prognosis should be th e main indication for urgent revascularization. One of the best predic tors of a poor prognosis in unstable disease is persistent pain despit e optimum therapy. Urgent surgery should be considered in any patient with multivessel coronary artery stenosis who has evidence of persiste nt myocardial ischaemia, despite adequate medical therapy.