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Chronic stable angina
Antiplatelets: Aspirin, Clopidogrel
Chronic stable angina
Anti-ischemic Tx
Beta Blockers:
First line Tx if noc C/I in pt w/ prior MI
Initial tx if not C/I in pts w/o prior MI
More effective than nitrates and CCB in silent ischemia
Effective as monotherapy or in combination w/ nitrates or CCB
Avoid in Prinzmetal's angina
Chronic stable angina
CCB:
Initial tx when BB are C/I
In combo w/ BB when initial BB tx is not successful
Avoid short acting DHP
Amlodipine and Felodipine can be used safely in pts w/ depressed LV systolic function
Chronic stable angina
Nitrates:
SL NTG or spray for immediate angina relief
Long acting nitrates as initial tx for symptoms if BB are C/I
Preffered agents in Prinzmetal's angina
In combo w/ BB or CCB, they produce greater effects
In pts w/ CAD or other vascular disease



Unstable angina/Non-STEMI (UA/STEMI)

Morphine
Oxygen
Nitrates
Aspirin
UA/STEMI
Anti-ischemic tx:
BB
- Preference is for and agent w/o ISA
- Agents w/ B1 selectivity are preffered in pts w/ bronchoconstrictive disease.
- Initial choices include: metoprolol, atenolol, and propranolol








UA/NSTEMI
CCB
CCB:
- No mortality benefit, not first line
- In pts w/ C/I to BB, a Non DHP should be used in the absence of LV dysfunction or other C/I
- Avoid short acting DHP





UA/NSTEMI
ACEI's
- Recommended in pt w/ HF, DM, pts w/ high risk CAD and in pts w/ persistent HTN not controlled by BB or nitrates
- HOPE trial show mortality benefit. May consider in all pts w/ CVD�w/o C/I.

UA/STEMI
Clopidogrel
- Alternative to ASA in pts w/ allergies
- Should be combined w/ ASA in pts undergoing stent� implantation for at least 1-6 month depending on the type of stent
- Should be combined w/ ASA in pts w/o a planned PCI procedure for up to 9 months


UA/STEMI
GP IIb/IIIa Is
Abciximab (ReoPro)
Eptifibatide (Integrilin)
Tirofiban (Aggrastat)
- Used as adjuntive therapy in pts undergoing PCI
- Integrilin and Aggrastat can also be used in pts who will be managed medically.
- Should be given to all pts with planned PCI procedure







UA/NSTEMI
Anticoagulant tx
Unfractionated heparin (UFH) and LMWH (Enoxaparin, Dalteparin)
- Should be given to all pts in combo w/ ASA and clopidogrel
STEMI
Morphine
Oxygen
Nitrates
ASA
Heparin
BB

STEMI
Nitrates

- Use w/i first 24 hrs in all MI pts who do not have Hypotension, bradycardia, or tachycardia.



STEMI
Fibrinolytic Tx
(Thrombolytic Tx)
- A door to neddle time <30 min goal
- ST segment elevation >1mm in 2 or more contiguous leads
- Presentation w/i 2 hours of sx onset
- Pt age >75 may be useful and appropriate
- Could be used if time to tx is 12-24 hrs
- Do not use if time to therapy >24 hrs






Drug eluting stents (DES)
Clopidogrel in combination w/ ASA is used to reduce in-stent thrombosis, and is used for at least 1 month w/ BMS, 3 months for sirolimus-coated, and 6 months for paclitaxel-coated stents.




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