The resulting coronary artery vasodilatation increases coronary oxygen supply. Preparations include oral, transdermal patches, ointment, sublingual tablets, or spray. A common side effect is headache, which usually responds to aspirin or acetaminophen and tends to improve with continued use. Patients should be instructed to go to the emergency department if angina is not relieved after 3 doses of nitroglycerin. ACE inhibitors, though not traditionally indicated for angina, may be useful in the patient whose symptoms are difficult to control.
ACE inhibitors reduce afterload and directly dilate coronary arteries.
Primary indication is angina refractory to medical therapy or lesions that are more amenable to surgery than to angioplasty. Advanced age with pronounced debility, absence of ischemia, or ungraftable coronary arteries. Advanced age in and of itself is not a contraindication. PTCA does not prevent MI or prolong life. There was general agreement among these trials that the procedures provide equal improvement in angina.