Cardiovascular System

Substernal chest pressure precipitated by exertion or emotional stress, lasting minutes, and relieved within 5 minutes by rest or sublingual nitroglycerin.

Exercise (treadmill) ECG stress testing; stress imaging (echo or myocardial perfusion) is used when the baseline ECG is uninterpretable or the patient cannot exercise.

Beta-blockers, which reduce heart rate and myocardial oxygen demand; calcium channel blockers are an alternative when beta-blockers are contraindicated.

Aspirin (antiplatelet) and a statin; these reduce events regardless of symptoms, unlike nitrates and beta-blockers which are mainly antianginal.

It is a venodilator that reduces preload and myocardial wall stress (and dilates coronary arteries), lowering oxygen demand; it acts within minutes for acute episodes.