Our own present management of patients with unstable angina pectoris is to hospitalize them in a coronary care unit and institute both long acting nitrates (as well as nitroglycerin for each episode of angina) and propranolol. These agents are increased stepwise until control of pain or significant reduction of blood pressure and heart rate occurs. Coronary arteriography is performed within a few days, in the absence of acute myocardial infarction, in order to determine the coronary artery anatomy. If the pain has not been alleviated with the medical program or if the patient has left main coronary stenosis (over 50 percent lumenal diameter narrowing) or three vessel disease, we advise early surgery. Otherwise the patient is followed and surgery may be planned electively if angina pectoris limits the lifestyle desired by the patient.