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● The drug of choice for acute pain relief is the short-acting nitrate glyceryl trinitrate.
● Prognostically, the most important are aspirin and statin treatments. Aspirin in LOW DOSE (75-100 mg/d), because higher doses are not only more toxic (gastro-intestinal bleedings!), but also less effective as the resulting endothelial COX2 inhibition causes vasoconstriction. If contraindicated or not tolerated, aspirin should be replaced with clopidogrel. If causing gastro-intestinal side-effects, aspirin can be combined with omeprazole.
● Statins are given irrespective of the initial lipid profile (fixed-dose approach). In case of side-effects, such as myalgia, reduce the dose then try another statin or switch to another class of lipid-lowering drugs such as fibrates (fenofibrate). Simvastatin is the most investigated statin but it may be replaced with fluvastatin in case of interactions with other CYP3A4 substrates.
● Beta blockers and angiotensin converting enzyme inhibitors are prescribed to most patients, but the benefits are most clear for those which already had a post-myocardial infarction or developed a congestive heart failure.
● Whether calcium channel blockers, used in instances of contra-indications or intolerance of beta blockers, are beneficial is controversial and these drugs should be discontinued in cases of unstable angina and in the first weeks post myocardial infarction.