Treatment of Unstable Angina

MAJOR presentations of coronary artery disease include sudden death, myocardial infarction, stable angina, unstable angina, and miscellaneous syndromes such as arrhythmias and left ventricular failure. While the prevalence of unstable angina is relatively low compared with other coronary disease syndromes, the potential for prevention of infarction and death is high, hence the importance of this review of current therapy. Clinical Presentations Two general presentations of unstable angina may occur: type I—(a) stable angina with a recent increase in frequency and severity of attacks, (b) recent onset angina with increasing frequency and severity of episodes; or type II—recent onset of rest angina of prolonged duration (usually >15 minutes), little relief from nitrates, and often associated with ST-T-wave changes, sweating, nausea, and other constitutional symptoms. The relative frequency of these presentations may vary. In a prospective study from this hospital, 62% of 228 patients with unstable angina had prior stable angina (type