Antianginals

A 58-year-old man with a 3-year history of stable angina presents to the emergency department with chest pain at rest lasting 20 minutes. He is on aspirin 75 mg daily and atenolol 50 mg once daily. On examination, BP is 145/92 mmHg, HR 88/min, and an ECG shows 2 mm ST depression in leads II, III, aVF with T-wave inversion. Troponin I is negative. What is the most appropriate immediate next step in management?

A 65-year-old woman with chronic stable angina controlled on amlodipine 5 mg daily and isosorbide mononitrate 40 mg once daily presents with increasing frequency of anginal episodes (now 4–5 times per week despite medication). She denies dyspnea, orthopnea, or lower limb edema. BP is 130/80 mmHg, HR 72/min, and echocardiography shows normal left ventricular function. What is the most appropriate next step in management?

Which antianginal drug is contraindicated in patients taking phosphodiesterase-5 inhibitors and why?

A 62-year-old woman with vasospastic angina (Prinzmetal's angina) and hypertension presents with recurrent chest pain at rest, especially in the early morning hours. Which drug is the preferred first-line treatment?

A 58-year-old man with a 3-year history of stable angina presents to the cardiology clinic. He reports chest discomfort on exertion that is relieved within 5 minutes of rest. His current medications include aspirin and atorvastatin. On examination, blood pressure is 145/92 mmHg and heart rate is 78/min. Resting ECG is normal. He is started on a long-acting nitrate (isosorbide mononitrate 60 mg once daily) and a beta-blocker (metoprolol 50 mg twice daily). After 2 weeks, he reports excellent symptom control. However, he now complains of a throbbing headache that occurs shortly after taking his morning dose of nitrate, though the headache resolves within 1–2 hours. What is the most appropriate management strategy?