We all know that patients with coronary heart disease need long-term oral drug therapy, which improve the prognosis of coronary heart disease can not be stopped, but for patients who have been symptomatic relief, no angina attack, some of the antimyocardial ischemic drugs can be discretionary to reduce or stop. At present, the main clinical drugs to reduce symptoms and improve ischemia include nitrates, beta-blockers, calcium antagonists, drugs to improve myocardial metabolism and other drugs. Below to talk to you specifically about the main anti-myocardial ischemia drugs are what? 1, nitrate drugs Nitrate drugs are endothelium-dependent vasodilators that can improve myocardial perfusion, reduce myocardial oxygen consumption and relieve angina symptoms. Mainly include short-acting nitrate nitroglycerin, long-acting nitrate isosorbide nitrate, isosorbide mononitrate, etc.. Sublingual nitroglycerin can be used for rapid symptomatic relief during angina attacks, and can also be applied a few minutes before activity to reduce or avoid angina attacks. Long-acting nitrates are used to reduce the frequency and severity of angina attacks and may increase exercise tolerance. Long-acting nitrates should not be used in acute episodes of angina, but are appropriate for the chronic long-term treatment of angina. Nitrates reflexively increase sympathetic tone and accelerate the heart rate, so they are often used in combination with beta-blockers, which may enhance the anti-ischemic effect and counteract the adverse effects of increased heart rate. Adverse effects of nitrates include facial flushing, headache, reflex acceleration of heart rate and hypotension, which are more pronounced with short-acting nitroglycerin. When applying nitrate drugs, we should pay attention to the adverse reactions and apply them according to the instruction manual or follow the doctor’s advice to avoid the occurrence of adverse time. 2, β-blocker β-blocker can inhibit cardiac β-adrenergic receptors, thus slowing down the heart rate, weakening myocardial contractility, lowering blood pressure, reducing myocardial oxygen consumption, reducing patients with angina pectoris attack, increase exercise tolerance. β-blocker at the same time both anti-myocardial ischemia and to improve the prognosis of the dual role, in the treatment of coronary artery disease has an important position. Beta blockers are contraindicated in patients with high atrioventricular block, sinus node dysfunction, significant bronchospasm or bronchial asthma. Peripheral arterial disease and severe depression are relative contraindications to the use of beta-blockers. In addition, if patients with symptomatic severe bradycardia (heart rate <50 beats/min), the dose should be reduced or suspended, rather than stopping the drug, otherwise it is easy to cause a rebound increase in heart rate, with the risk of causing myocardial ischemia or angina pectoris symptomatic recurrence. 3.Calcium antagonists Calcium antagonists (diphenhydramine class) by improving coronary blood flow and reduce myocardial oxygen consumption, play the role of anti-angina, for variant angina or angina with coronary artery spasm as the main angina, calcium antagonists are the first-line therapeutic drugs. Diltiazem and verapamil slow atrioventricular conduction and are commonly used in patients with angina pectoris associated with atrial fibrillation or atrial flutter. These two drugs should not be used in patients with preexisting severe bradycardia, high degree of atrioventricular block, and morbid sinus node syndrome. Long-acting calcium antagonists (e.g., nifedipine controlled-release tablets, amlodipine, etc.) reduce anginal episodes. the combination of beta-blockers and long-acting calcium antagonists is more effective than a single drug. The nondihydropyridine calcium antagonists diltiazem or verapamil may be used as alternative therapy in patients with contraindications to beta-blockers. However, the combination of a non-dihydropyridine CCB and a beta-blocker can result in more pronounced conduction block and diminished myocardial contractility. For the elderly, patients with existing bradycardia or left ventricular dysfunction should be avoided. 4.Improve myocardial metabolic drugs Trimetazidine (Wan Shuang Li) through the regulation of myocardial energy substrate, inhibit fatty acid oxidation, optimize myocardial energy metabolism, improve myocardial ischemia and left heart function, relieve angina pectoris. It can be used in combination with beta-blockers and other anti-myocardial ischemic drugs. 5, other classes of anti-myocardial ischemic drugs Nicorandil: Nicorandil has a unique dual pharmacological mechanism, can specifically open the coronary artery vascular smooth muscle potassium channels, improve microvascular function, dilate coronary artery microvessels and improve myocardial blood supply, but also has a class of nitrate-like effect, dilate coronary arteries, stable angina pectoris and other types of angina pectoris have significant efficacy. Proprietary Chinese medicines, such as Danshen drip pill, Tongxinluo capsule, quick-acting heart-saving pill, etc. have the effect of improving angina pectoris symptoms and anti-myocardial ischemia.