chest pain due to transient myocardial ischamia

relieved by rest or sublingula nitroglycerin

Management

• most important intervention = smoking cesastion

• weight loss not shown to increase survival

medications

• aspirin

  • NNT 42 - ISIS2

  • given routinely and continued for life

• ticagrelor

• clopidogrel

  • effective alternative

  • often in combination = 1yr

  • 75mg

• Warfarin

  • AF/PAF

  • large left ventricular aneurysm

  • thrombus in LV at infarction site on ECHO

  • systemic embolism

  • INR 2.5 (2-3)

• Betablockers

  • NNT 143; ISIS1

  • considered for everyone unless CI

  • also with LV dysfunction

  • initial dose low

  • give at night

    • reduce risks of postural hypotension

    • alleviate symptoms of tiredness and lethargy

  • before discontinuing beta-blockers because of side-effects, lower dose or alternative betablocker should be tried

• ACEi

  • NNT 22 - SOLVD

  • should be considred

  • especially:

    • ant. infarct/

    • LV dysfucntion

    • CHF

  • PROGRESS/HOPE

    • favourable outcomes independent of a blood pressure effect post MI

• Statins

  • NNT 33 - CARE

  • should be started after MI

• CCB

  • rate limiting non-dihydropyridine CCB

    • verapamil

    • diltiazem

• Nitrates

  • symptom relief

  • not indicated for reducing risk of further events