Which medication should be prescribed to all angina patients to treat an acute attack?

The preferred medication to treat an acute angina attack is a nitroglycerin sublingual tablet or spray. This choice is optimal because it provides rapid relief of angina symptoms. When taken sublingually, nitroglycerin is absorbed quickly through the oral mucosa, allowing it to act almost immediately to alleviate chest pain caused by angina.

Nitroglycerin works by inducing vasodilation, which improves blood flow to the heart muscle and reduces the workload on the heart. This is particularly beneficial in acute situations where immediate relief is necessary to prevent further exacerbation of symptoms. The sublingual form is specifically designed for quick absorption and effectiveness during an angina episode, making it the standard treatment in such scenarios.

In contrast, isosorbide dinitrate is often used for long-term management of angina but does not act as fast as sublingual nitroglycerin in acute situations. The nitroglycerin patch is intended for prevention of angina symptoms rather than immediate treatment, and ranolazine is also more suited for the chronic management of angina rather than acute symptom relief.