Along with beta blockers, ACE inhibitors can also be used since they retard progression of coronary artery disease. These drugs act by inhibiting the activity of the enzyme which decreases the production of angiotensin II. They must be used in caution while using with other drugs because of their potential to increase potassium levels. Statins are used to control hypercholesterolemia. These include atorvastatin, simvastatin, pravastatin, lovastatin and fluvastatin. Their use leads to significant improvement in endothelium-dependent dilation of coronary and peripheral arteries in patients with hyperlipidemia. They also have the advantage of stabilizing atheromatous plaques in coronary arteries and may even contribute to regression of coronary atherosclerosis (Zevitz, 2006).
The cornerstone of medical treatment in both patients with symptomatic and those with asymptomatic myocardial ischemia is antianginal medications. The drugs which fall in to this category include beta blockers, calcium channel blockers such as nifedipine, felodipine, and amlodipine, and nitrates. These drugs act by increasing blood supply into the coronary arteries. Long-acting nitrates are effective in the treatment of myocardial ischemia and are frequently used in combination with both beta-blockers and calcium channel antagonists. Short-acting nitroglycerin is the agent of choice in the treatment of acute symptomatic myocardial ischemia (Zevitz, 2006).
The antiplatelet drugs which may be used are aspirin, clopidogrel, ticlopidine, or dipyridamole. Of these, aspirin is most effective in reducing risk for MI. These drugs act by decreasing platelet aggregation and inhibiting thrombus formation. They are effective in the arterial circulation, where anticoagulants have little effect.
The goal of pharmacotherapy in CCF is to achieve a PCWP of 15-18 mm Hg and a cardiac index >.2.2 L/min/m2, while maintaining adequate blood pressure