The aim of drug therapy is twofold:
Anti-ischaemic, eg B-blocker, nitrate, calcium channel antagonist.
Antithrombotic, eg aspirin, low molecular weight heparin, abciximab, which interfere with platelet activation, and so reduce thrombus formation.
Further measures:
Wean off glyceryl trinitrate (GTN) infusion when stabilized on oral drugs.
Stop heparin when pain-free for 24h, but give at least 3-5 days of therapy.
Check serial ECGs and cardiac enzymes for 2-3d.
Address modifiable risk factors: smoking, hypertension, hyperlipidaemia, diabetes.
Gentle mobilization.
รข–¶If symptoms recur, refer to a cardiologist for urgent angiography and angioplasty or CABG.
Prognosis
Overall risk of death ~1-2%, but ~15% for refractory angina despite medical therapy. Risk stratification can help predict those most at risk and allow intervention to be targeted at those individuals. The following are associated with an increased risk:
Haemodynamic instability: hypotension, pulmonary oedema.
T-wave inversion or ST segment depression on resting ECG.
Previous MI.
Prolonged rest pain.
Older age.
Diabetes mellitus.
Indications for consideration of invasive intervention:
Poor prognosis, eg pulmonary oedema.
Refractory symptoms.
Positive exercise tolerance tests (ETT) at low workload.
Non-Q wave MI.
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