Unstable angina encompasses a wide range of clinical presentations of myocardial ischemia, usually caused by sudden deteriorations of coronary lesions. Sometimes, extracardiac conditions disturbing the oxygen balance, such as severe anaemia, fever or thyrotoxicosis, may cause myocardial ischemia. In this thesis unstable angina is referred to as myocardial ischemia due to obstructive atherosclerotic coronary artery disease. In the literature and in clinical practice a variety of definitions is used to describe this particular clinical situation. These definitions are characterised by the description of chest pain, the clinical circumstances under which unstable angina occurs, the presence or absence of concomitant ECG changes during pain, and the intensity of treatment before pain occurs· Patients with anginal symptoms of unstable character, and no signs of acute myocardial infarction, are athnitted with an initial diagnosis of unstable angina pectoris. An observation period is necessary to come to a definite final diagnosis, as myocardial infarction may have already occurred in a number of such patients, but can not he recognised until an increase in cardiac enzyme concentrations can be detected in the circulation. Thus in addition to the characteristics of clinical signs and symptoms also the time of definition is of importance to characterise the patient population. Treatment of unstable angina is directed to relief of acute symptoms and to prevent progression to myocardial infarction or death. Various drugs are available, acting upon different underlying pathophysiologic mechanisms, and thereupon bypass surgery and angioplasty may be used to improve tl1e coronary blood supply. In the present study the application of these treatment options in the management of patients hospitalized for suspected unstable angina is described. Furthermore it was assessed how physicians in different hospital senings apply each of the alternative management strategies in their practice. Finally. the prognosis under the current management strategy is described.

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Financial support by the Netherlands Heart Foundation and the Center for Clinical Decision Sciences for the publication of this thesis is gratefully acknowledged.
M.L. Simoons (Maarten)
Erasmus University Rotterdam
hdl.handle.net/1765/40723
Erasmus MC: University Medical Center Rotterdam

van Miltenburg-van Zijl, A. (1992, June 17). Management policies and prognosis in unstable angina pectoris : use of coronary angiography in different practice settings. Retrieved from http://hdl.handle.net/1765/40723