Cardiology doctors in yelahanka New Town, Bangalore . Beta-blockers These cheap, effective anti-anginal drugs reduce cardiac work and oxygen requirements. They improve the prognosis for patients who have had a myocardial infarction (up to 30% relative risk reduction for death or further myocardial infarction15) but seem not to do so for patients with angina.16 They should be the drug of first choice for the treatment of angina unless one of their many side effects prevents their use. They are contraindicated for people with asthma or chronic obstructive pulmonary disease as they may cause bronchospasm in these patients. They cause a dose-related bradycardia and may be difficult to use in patients with a slow resting heart rate. Beta-blockers with intrinsic sympathomimetic activity (e.g. pindolol) seem less effective. The most common side effect patients complain of is tiredness. This may improve with time or if a long-acting beta-blocker (e.g. atenolol) is given at night, but overall remains a common reason for stopping the drug. Patients with peripheral vascular disease will often notice a deterioration in their symptoms. Beta-blockers should not be ceased suddenly since this can precipitate unstable angina or even infarction. It is not uncommon for the onset of angina to occur when a beta-blocker used for hypertension is changed to a different anti-hypertensive agent. THE PATIENT WITH CHEST PAIN If there is concern about side effects or the presence of relative contraindications (e.g. possible mild asthma), a small dose of a shorter-acting drug should be used. The selective beta-blocker metoprolol at 25–50 mg twice a day may be a reasonable drug to start with. The maximum useful dose of this drug is usually 100 mg twice a day. Atenolol is a longer acting beta-blocker. It is useful given as a once-a-day dose of 25–50 mg but there is less evidence of the benefits of this drug (for angina, rather than hypertension) than for metoprolol