1) Treat underlying problem ie. Anemia, hyperthyroidism
2) Manage coexist problem ie. DM, HPT
3) Evaluate risk factor & control it ie. Smoking, obesity
4) Medical therapy vs revascularization
Medical therapy
a) Prognostic therapy
- Tab aspirin 75 mg daily, po
- Lipid lowering drug in pt:
i) With total cholesterol above 4.8 mmol/L.
ii) LDL more than 3.3 mmol/L
iii) HDL less than 1.0 mmol/L
iv) If TG less than 3.5 mmol/L use statin. Atorvastatin 10-20 mg daily or simvastatin 20-40 mg daily, pravastatin 40 mg daily and rosuvastatin 10-20 mg daily.
v) If TG more than 3.5 mmol/L use fibrate
b) Symptomatic
- Sublingual GTN 0.3-0.5 mg at 5 minutes interval to a max 3 tab.
- Beta blocker, tab. atenolol 50-100 mg bds, po or tab. Metaprolol 25-50 mg bds, po if renal function impaired
- Calcium channel blocker like ca2t antagonist (diltiazem, verapamil) or short acting dihydropyrides (nifedipine)
- Long acting nitrates for eg; isosorbide mononitrate (c/I with sildanefil)
- Pottasium channel activator (nicorandil)
