[Treatment of unstable angina].
Adequate treatment of unstable angina, initiated soon enough in the setting of a coronary care unit, avoids evolution towards myocardial infarction in more than 90% of the patients. Treatment consists of a combination of anti-thrombotic and anti-ischemic therapies. Oral beta-adrenergic blockers and intravenous nitrates represent the usual anti-ischemic treatment; calcium antagonists will be prescribed as an adjunct therapy if the response is insufficient or if a vasospastic mechanism is suspected. Anti-thrombotic treatment usually consists of a combination of low dose aspirin and intravenous heparin. Twelve hours are usually sufficient to titrate this medical regimen and to assess its efficacy; if myocardial ischaemia persists or recurs despite this therapy, urgent coronary angiography and subsequent revascularization are warranted. Usually ischaemia is adequately controlled by medical therapy, elective coronary angiography is nevertheless useful to screen high risk patients (left main and severe three-vessel disease) needing coronary artery bypass graft. In most cases however revascularization, by surgery or angioplasty, will be considered only if ischaemia at rest or induced by exercise, recurs despite optimal medical treatment.
Spaulding
C
C
Service des maladies cardiovasculaires, Hôpital Cochin, Paris.
Weber
S
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000789:Angina, Unstable / Q000503:physiopathology / Q000628:therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009204:Myocardial Revascularization; D009566:Nitrates / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D005343:Fibrinolytic Agents; D009566:Nitrates
Traitement de l'angor instable.