In cases of chronic stable angina, what treatment is typically recommended for acute symptom relief?

Sublingual nitroglycerin is the preferred treatment for acute symptom relief in chronic stable angina due to its rapid onset and efficacy in dilating coronary arteries. When a patient experiences chest pain or angina, sublingual nitroglycerin acts within minutes by releasing nitric oxide, which relaxes and dilates the vascular smooth muscle. This helps to improve blood flow to the heart muscle and alleviate the ischemic pain associated with angina.

In contrast, other options like metoprolol or calcium channel blockers serve more as long-term management strategies to reduce the frequency of angina episodes, rather than providing immediate relief. Metoprolol, a beta-blocker, helps to lower heart rate and myocardial oxygen demand but does not act quickly enough for acute symptom relief. Calcium channel blockers are also used for long-term management by reducing vascular resistance and improving coronary blood flow, but again, they are not intended for quick alleviation of acute symptoms. ACE inhibitors primarily address issues like hypertension and heart failure and do not play a role in the immediate management of angina symptoms. Thus, sublingual nitroglycerin is the most appropriate choice for rapid relief during an angina attack.