AnginaMx in afya

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lifestyle changes, medication, percutaneous coronary intervention and surgery.
NICE 2011

''Medication''
all get aspirin and statin 
S/L GTN acutley
1st line - BB or CCB (depending on co-morbidity and personal preference), inc to max dose then add in other
if CCB mono - use rate limiting (Verapamil or Diltiazem)
if CCB with BB use long acting dihydropyridine (Nifedipine) 
DON'T give BB with Verapamil (risk of heart block)

If on monotherapy and unable to add BB/CCB then add long-acting nitrate, ivabradine, nicorandil or ranolazine
If on BB and CCB already use 3rd drug only whilst awaiting angio and ?PCI or CABG

''Nitrate'' tolerance - common
suggest take second dose after 8 hrs not 12 so time off over night
not see with modified release ISMN

''Ivabradine''
reduces heart rate (acting on If ion current in SA node so dec pacemaker activity
new drug - no evidence better than old drugs
SE 
visual (esp luminous phenomena)
bradycardia

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