A 65-year-old man with a history of CHD complains of chest pain occurring increasingly often and with less exertion than before. His current medications include aspirin, a statin, and a beta-blocker. His ECG is unchanged from previous. What could be the diagnosis and the next steps?
This patient's symptoms suggest worsening stable angina, now becoming unstable. Unstable angina is part of acute coronary syndrome (ACS) and denotes a worsening of previously stable coronary heart disease. The patient should be admitted to the hospital for monitoring and medical management, which may include increasing the dose of his beta-blocker, adding a long-acting nitrate or calcium channel blocker, and introducing a second antiplatelet agent such as clopidogrel. He would also likely require further evaluation with a coronary angiogram.