Management of patients with unstable angina in a general cardiology unit.

AIMS: To review the clinical management of patients with unstable angina and to relate prospectively initial risk stratification, according to the Braunwald criteria, to subsequent cardiovascular events. METHODS: From February to April 1996 we performed a three month prospective review of all patients with a diagnosis of unstable angina admitted to the coronary care unit at Auckland Hospital. RESULTS: One hundred and four patients (61% male), with a mean age of 64 years, were classified as high (58%), intermediate (41%) or low risk (1%) for an adverse cardiac event. Twelve (12%) patients had a documented myocardial infarction, of whom 11 were in the high-risk group (p = 0.038). During hospitalisation there was one death. Twelve (12%) patients underwent inpatient exercise testing, five of whom proceeded to a coronary angiogram prior to hospital discharge. Twenty-two (21%) unstable patients underwent inpatient angiography without prior exercise testing. Twenty-one (20%) patients required revascularisation on the same admission: percutaneous coronary angioplasty (n = 14) or coronary artery bypass grafting (n = 7). Twelve of these 21 patients were in the high-risk group (p = 0.999, NS). CONCLUSION: Patients admitted with unstable angina had low inpatient mortality but a 12% rate of subsequent myocardial infarction. Braunwald low-risk unstable angina patients were not admitted to the coronary care unit. Braunwald high-risk patients were more likely to develop a subsequent myocardial infarction. Stratification of patients into intermediate or high-risk groups did not relate to initial medical management or subsequent revascularisation. Thus, while this method of risk stratification may predict cardiovascular events, it may be of limited clinical use in the New Zealand environment.

Relationship of racial stressors to blood pressure responses and anger expression in black college students.

The physiological effects of racism, as a stressor, were examined as they related to blood pressure (BP) and anger experiences in Black college students. Current research has failed to consider the stressful effects of racism as a factor contributing to the higher incidence of essential hypertension among Blacks. Twenty-seven Black college students viewed three excerpts showing racist situations involving Blacks; anger-provoking, nonracist situations; and neutral situations. After each scene, BP was taken, and a mood checklist was administered. The Framingham Anger Scale and the Anger Expression Scale were administered. Analyses revealed that BP significantly increased during the presentation of racist stimuli but not of anger-provoking or neutral stimuli. Self-reports of state anger, as measured by the mood checklist, were significant for both the anger-provoking and racist stimuli. BP scores were significantly correlated to the two trait anger measures. Exposure to racist stimuli was associated with BP increases among Blacks. Such cumulative exposure to racism may have important implications for the etiology of essential hypertension.