In summary, with the foregoing information available, the current approach to a patient such as the one under discussion would be admission to the Coronary Care Unit for observation and initiation of progressively increasing doses of anti-anginal medications, including calcium-blocking agents. If symptoms are controlled the patient generally undergoes cardiac catheterization on an elective basis, and a decision regarding coronary bypass grafting is made on the basis of the anatomy and the overall clinical picture. When symptoms cannot be managed satisfactorily with medical therapy, insertion of the intra-aortic balloon pump and urgent cardiac catheterization is advised. This approach was taken in the patient discussed earlier, and thus far appears to have been eminently successful.