Key messages

• Ischemic heart disease is so common in men from middle life onwards that all complaints of chest pain in this group should be considered to be cardiac in origin until proven otherwise.

• Unstable angina (chest pain at rest or with diminishing exercise tolerance) may progress to myocardial infarction. It is not yet clear whether conservative (medical) or invasive (endoluminal or surgical revascularization) management is best, but thrombolysis has no advantages.

• Non-cardiac surgery is stressful to all patients with coronary artery disease. Therefore careful preoperative assessment is merited in all patients, particularly those whose primary disease indicates high cardiac risk (e.g. peripheral vascular disease or surgery for lung cancer).

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