Emergency management for unstable angina includes which of the following?

• A. Antibiotics and diuretics
• B. Anticoagulants only
• C. Aspirin, nitrates, oxygen if SaO2 < 95%
• D. Immediate surgery

Answer: (C)

In unstable angina, the immediate goal is to prevent thrombosis, relieve ischemia, and ensure adequate oxygen delivery to the heart muscle. The combination of aspirin, nitrates, and oxygen if the patient is not well oxygenated fits that goal perfectly.

Aspirin is used right away because it blocks platelet aggregation, reducing the chance of a clot growing and causing a heart attack. Nitrates help by dilating vessels, which lowers the heart’s oxygen demand and improves blood flow to the ischemic area, often relieving chest pain quickly. Oxygen is given when the patient is hypoxemic to improve oxygen delivery to the myocardium; routine oxygen for every patient isn’t necessary, so the focus is on those with low oxygen saturation.

Antibiotics and diuretics aren’t part of the standard initial management for unstable angina unless there’s another reason for them (infection or volume overload). Immediate surgery isn’t the first move in unstable angina; stabilization with antiplatelet therapy, anti-ischemic treatment, and oxygen comes first, with surgery reserved for specific high-risk cases or if ischemia persists despite medical therapy. Anticoagulants are used as part of treatment, but they don’t replace the need for aspirin and nitrates or the oxygen strategy.