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Cover of Unstable Angina: Diagnosis and Management

Unstable Angina: Diagnosis and Management

AHCPR Clinical Practice Guidelines, No. 10

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Rockville (MD): Agency for Health Care Policy and Research (AHCPR); .
Report No.: 94-0602

Recommendations on the care of patients with unstable angina made in this clinical practice guideline are based on a combination of evidence obtained through extensive literature reviews and, in cases where evidence was lacking, on the consensus opinions of the expert panel. Principal conclusions of this guideline include:

  • Many patients suspected of having unstable angina can be discharged home after adequate initial evaluation.
  • Further outpatient evaluation of patients with symptoms of unstable angina judged at initial evaluation to be at low risk for complications should be concluded within 72 hours after initial presentation.
  • Patients with unstable angina judged to be at intermediate or high risk of complications should receive aspirin, heparin, nitroglycerin, and beta-blocker therapy and should be hospitalized for careful monitoring of their clinical course.
  • Intravenous thrombolytic therapy should not be administered to patients without evidence of acute myocardial infarction.
  • Assessment of prognosis by noninvasive testing often aids selection of appropriate therapy.
  • Coronary angiography is appropriate for patients judged to be at high risk for cardiac complications or death based on their clinical course or results of noninvasive testing.
  • Coronary artery bypass surgery should be recommended for almost all patients with left main disease and many patients with three-vessel disease, especially those with left ventricular dysfunction.
  • The discharge care plan should include continued monitoring of symptoms, appropriate drug therapy including aspirin and risk factor modification, and counseling.

Contents

Suggested citation:

Braunwald E, Mark DB, Jones RH et al. Unstable Angina: Diagnosis and Management. Clinical Practice Guideline Number 10. AHCPR Publication No. 94-0602. Rockville, MD: Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, Public Health Service, U.S. Department of Health and Human Services. May 1994 (amended).

Bookshelf ID: NBK52327
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