A critical proximal left anterior descending coronary artery stenosis associated with unstable angina places a patient at extreme risk for extensive anterolateral myocardial damage with potentially irreversible hemodynamic demise. Characteristics of this pathology are a clinical profile of new-onset unstable angina, normal or minimally elevated cardiac enzymes, and 12-lead electrocardiographic indicators specific for anterolateral ischemia usually seen in periods when the patient is pain-free. Knowledge of this profile, administration and evaluation of pharmacologic therapies and a unique bedside monitoring strategy with hourly surveillance of the precordial leads are key measures necessary to stabilize and preserve the integrity of myocardial tissue until aggressive, invasive revascularization therapies are instituted.

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