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- Nitroglycerin 0.3-0.6 mg sublingually or by buccal spray. If chest discomfort persists after three doses given 5 min apart, consider IV nitroglycerin (5-10 µg/min, then increase by 10 µg/min every 3-5 min until symptoms relieved or systolic bp <100 mmHg). Do not use nitrates in pts with recent use of phosphodiesterase-5 inhibitors for erectile dysfunction (e.g., not within 24 h of sildenafil or within 48 h of tadalafil).
- Beta blockers (e.g., metoprolol 25-50 mg PO q6h) targeted to a heart rate of 50-60 beats/min. In pts with contraindications to beta blockers (e.g., bronchospasm), consider long-acting verapamil or diltiazem (Table 166-1) if LV contractile function is not impaired.
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