Postinfarction unstable angina. Pathophysiologic basis for current treatment modalities.
Unstable angina is an acute coronary syndrome characterized by the rapid progression of clinical symptoms which may culminate in acute myocardial infarction, infarct extension or sudden death. The pathologic substrate involves atherosclerotic plaque rupture with platelet deposition, thrombus formation and coronary arterial spasm. Patients with postinfarction angina represent a high-risk subgroup with severe multivessel disease, compromised collateral vessels and/or partially occlusive thrombi; their risk of infarct extension and death is significantly increased. Initial therapy includes nitrates, beta-adrenergic blockers, calcium channel antagonists, aspirin and possibly i.v. heparin, as well as prompt identification and control of exacerbating factors. Thrombolytic therapy may assume a more central role based on its ability to achieve rapid clinical stabilization. Percutaneous transluminal coronary angioplasty and coronary artery bypass grafting may be used emergently in patients refractory to medical therapy, or electively when clinically indicated.
Becker
R C
RC
Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester 01655.
Gore
J M
JM
Alpert
J S
JS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000787:Angina Pectoris / Q000628:therapy*; D000789:Angina, Unstable / Q000209:etiology / Q000628:therapy*; D000800:Angioplasty, Balloon; D001243:Assisted Circulation; D002985:Clinical Protocols; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications; D003328:Coronary Thrombosis / Q000150:complications; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*; D009566:Nitrates / Q000627:therapeutic use; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D006493:Heparin