Diagnosing and Managing Unstable Angina

Abstract

This Quick Reference Guide for Clinicians contains recommendations on the care of patients with unstable angina based on a combination of evidence obtained through extensive literature reviews and consensus among members of a private‐sector, expert panel. Many patients suspected of having unstable angina can be discharged home after adequate initial evaluation. Further outpatient evaluation may be scheduled for up to 72 hours after initial presentation for patients with clinical symptoms of unstable angina judged at initial evaluation to be at low risk for complications. Patients with acute ischemic heart disease judged to be at intermediate or high risk of complications should be hospitalized for careful monitoring of their clinical course. Intravenous thrombolytic therapy should not be administered to patients without evidence of acute myocardial infarction. Assessment of prognosis by noninvasive testing often aids selection of appropriate therapy. Coronary angiography is appropriate for patients judged to be at high risk for cardiac complications or death based on their clinical course or results of noninvasive testing. Coronary artery bypass surgery should be recommended for almost all patients with left main disease and many patients with three‐vessel disease, especially those with left ventricular dysfunction. The discharge care plan should include continued monitoring of symptoms; appropriate drug therapy, including aspirin; risk‐factor modification; and counseling.This guideline describes principles of patient care derived from systematic analysis of scientific literature and from opinions of the expert panel when evidence was lacking. Diagnostic and management strategies recommended are as reasonable and safe as possible, given the current state of medical knowledge. Descriptions of usual approaches to care are expected to provide starting points for management of individual patients. However, adherence to this or any other guideline will not ensure perfect medical outcomes. Even the most careful application of current medical knowledge and procedures cannot eliminate all risk in the management of patients with unstable angina. This Quick Reference Guide for Clinicians contains excerpts from the Clinical Practice Guideline, Unstable Angina: Diagnosis and Management. Practitioners should review the Clinical Practice Guideline carefully to become familiar with the diagnosis and treatment options for patients with unstable angina and then use the Quick Reference Guide to help them remember major decision points.