A. Pathophysiology and Symptoms
The pathophysiology of unstable angina has been identified. In the majority of cases, disease-causing plaques are asymmetric with irregular borders and a narrow neck. Platelets then aggregate on the surface of plaques forming small thrombi. Lipid-rich plaques have a predilection for rupture, and rupture of the plaque with an overlying thro¬mbus is a common finding on angioscopy. Silent ischemia is fatal and observed in patients with unstable angina. Prognosis appears to be worse in this subset of patients.
Unstable angina patients represent a heterogeneous group. Patients usually present with chest pain at rest lasting from about 10 to 40 minutes; pain usually lasts more than 20 minutes but less than hour. Patients with stable angina with chest pain only on exertion who develop pain with much lower levels of activities or pain at rest are a subset of unstable angina. Patients with new onset angina occurring within the past 30 days have high-risk unstable angina.
B. Management
All patients with unstable angina should proceed to
an emergency room and be administered 160 mg of
chewable aspirin immediately if they have not already
taken the drug.

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