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''Aim''
relieve acute Sx and avoid hospitalisation
prevent / slow disease progression, reducing risk of cardiovascular events
improve exercize tolerance / quality of life

Nitrates are good for Sx control
long term preventatives .... BB first line, but often need multiple drugs
add in ... CCB, then long acting nitrates, nicorandil (K channel opener), Ranolazine, Ivabradine

look at CVS risk score and treat - aspirin ACEi etc
also consider role of stress anxiety and depression

pain in chest, jaw, back or arms
exacerbated by exersize, cold, stress
mostly caused by coronary athersclerosis but also by HT, anaemia, HOCM, valvular disese, vasospasm

predictable pain occuring >2/12, typically provoked by exertion and relieved by rest and nitroglycerin
risk factors - cholesterol, smoking, diabetes, male, age, FH, obesity, HT, inactivity, (thyroid)

note - unstable angina - lasts more than 30 mins, not predictable, at rest, post MI or procedure, recent onset, progressive - medical emergency

beware atypical presentations (esp women, elderly, diabetes) at rest / night, infra-mammary, sharp or variable pain

refer - most unless reason not to - for risk stratification - use exersize ECG or now more myocardial perfusion scan or dobutamine stress echo

''Nitrates''
dec myocardial oxygen demand by inc systemic vasodilation
relieves / prevents Sx
SE - headache, flushing, postural hypotension
use sub-lingually, up to 3 doses in 15 mins, discard tabs after 8/52
CI - outflow tract obstruction - AS or hypertrophic cardiomyopathy

''BB'' (bisoprolol - sotalol if has arrythmyias)
prevent exersize related to inc in pulse so prevent angina
SE - bradycardia, bronchospasm, fatigue, sleep disturbance, cold extremity / numbness, mask hypoglyc
CI - asthma, severe peripheral arterial disease, sick sinus syndrome, heart block (2or3), beware with COPD and don't give with Verapamil
note - they reduce Sx and ischaemia but only change mortality in pts with reduced LV function
don't use in vasospasm (Prinzmetal)

''CCB''
cause vasodilation and decreased contractility
2 groups - diltiazem / verapamil - neg inotropic less vasodilation -  and amlodipine - potent vasodilator
SE - flushing, headache, constipation, bradycardia, heart block, worsens failure (esp diltiazem and verapamil - can use amlodipine if controlled), beware in aortic stenosis 
use diltiazem or verapamil if alone, amlodipine with BB.
Verapamil - constipation and gingival hyperplasia

''Long acting nitrates''
reduce myocardial demand
SE - headache, postural hypotension
avoid in aortic stenosis, with sildenafil
beware tolerance - have 8 hour nitrate free per day