Unstable angina

Overview:

• Is a medical emergency which, untreated, will progress to an MI in over 10% of cases
• Standard therapy (see below) reduces this rate to less than 5%
• However, death within 1 year still occurs in 5-15%

Immediate treatment:

• Heparin 5000U IV bolus then IVI to maintain APPT 1.5-2.5
• Diltiazem 60mg PO TDS
• Atenolol 50-100mg PO OD
• Isosorbide dinitrate 2-20mg/h IVI
• Aspirin 75mg PO OD
• Monitor closely on CCU and exclude (and prevent impeding) MI

Subsequent management:

Those at high risk:

• Should proceed promptly to angiography, with a view to proceeding to revascularisation, where appropriate, during that admission

Those at low risk:

• Discharged and assessed electively as outpatients