For a patient experiencing substernal chest pain relieved by rest, what is the indicated therapy for acute management?

In cases of substernal chest pain that is relieved by rest, this presentation is commonly associated with angina pectoris, particularly stable angina. Sublingual nitroglycerine serves as a rapid-acting vasodilator and is effective in providing acute relief from the chest pain caused by myocardial ischemia. When administered sublingually, nitroglycerin quickly relaxes smooth muscle in the coronary arteries and peripheral vasculature, which helps to reduce cardiac workload and improve blood flow to the heart. This makes it particularly suitable for acute management of angina symptoms.

The other therapies listed serve different roles in cardiac care. Metoprolol is a beta-blocker that can help manage heart rate and decrease myocardial oxygen demand over a longer period, but it is not the first-line therapy for acute chest pain. Verapamil, a calcium channel blocker, can also reduce myocardial oxygen consumption and is effective for chronic management of angina. Lisinopril, an ACE inhibitor, is primarily used for long-term management of hypertension and heart failure and does not provide immediate relief for acute anginal symptoms. Therefore, sublingual nitroglycerin is the preferred therapy for quickly alleviating acute chest pain associated with ischemia.