Unstable angina is defined as chest pain occurring on a background of diminishing exercise tolerance or at rest. The diagnosis requires previously identified coronary artery disease or the association of symptoms with transient ECG changes of ischemia. The pathology is recognized as that of an unstable plaque with superadded platelet thrombus, but thrombolytic therapy is of no proven benefit. Patients who present with unstable angina have an approximately 15 per cent chance of a further acute event (myocardial infarction or death) within the next year. Treatment is conservative with bed rest, oral aspirin, b-blockers, and calcium-channel blockers, and initially intravenous nitrates and heparin, until no further pain at rest is experienced. Alternatively, early investigation and endovascular or surgical revascularization may be required. The optimal treatment is as yet undefined, and so either approach is appropriate, depending on resources.
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