Pharmacologic management of angina and acute myocardial infarction

A concise overview of the pharmacologic management of chronic stable angina, unstable angina, and acute myocardial infarction is presented. Nitrates, β blockers, and calcium antagonists increase exercise tolerance and decrease symptoms in patients with chronic stable angina, and aspirin may prevent myocardial infarction. In unstable angina, aspirin reduces mortality; heparin may prevent myocardial infarction; and nitrates, β blockers, calcium antagonists, and heparin may decrease angina. In acute myocardial infarction, thrombolytic therapy, aspirin, β blockers, and intravenous nitrates may decrease mortality, whereas calcium antagonists do not affect mortality. Intravenous magnesium may decrease the incidence of ventricular tachycardia, ventricular fibrillation, and mortality in patients with acute myocardial infarction. The administration of angiotensin-converting enzyme (ACE) inhibitors after the acute phase of myocardial infarction may decrease mortality and prevent reinfarction in patients with left ventricular dysfunction.