Monitoring

Continuous rhythm monitoring is recommended until non-ST elevation myocardial infarction has been established or ruled out. Patients with unstable angina (troponin negative) without recurrent or ongoing symptoms and normal ECG can be monitored on a regular ward, but those with non-ST-elevation acute coronary syndrome should have rhythm monitoring.[1]

Low-risk patients are defined by the absence of recurrent chest pain, ECG changes, serum cardiac markers, and findings of heart failure.[143] These patients should undergo non-invasive testing (using either exercise or pharmacological stress, and echo or nuclear imaging modalities) prior to hospital discharge and require aggressive risk factor modification. 

Patients initially treated conservatively should be re-evaluated 2-6 weeks after discharge. They should be assessed for cardiac catheterisation and revascularisation, based on symptoms and non-invasive testing.[2]​​

Clinicians caring for cardiac patients need to be aware of the high incidence of major depressive disorder in this population, and its association with worsened cardiovascular outcomes.[138]​​​[139]​​[144]​​​​ Accordingly, screening for symptoms of depression should be performed and therapy, including pharmacological, should be offered.[138]​​​[139]​​[145]​​​​​​

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