AF is the most common of these arrhythmias and may develop in >20% of patients. AF is associated with shock, HF, stroke, and Management ofAF requires rate control and adequate anticoagulation according to the 2014 For hemodynamically unstable patients and those with continuing ischemia, treatment should be implemented according to the 2010 advanced cardiac life support CPGs.585 Cocaine and methamphetamine users (cont'd) It is reasonable to use benzodiazepines alone or in combination with NTG to manage hypertension and tachycardia and signs of acute cocaine or methamphetamine intoxication IIa C 741 744 Do not administer beta blockers to patients with recent cocaine or methamphetamine use who have signs of acute intoxication due to risk of potentiating coronary spasm III: Harm C N/A Vasospastic (Prinzmetal) angina Recommend CCBs alone or in combination with nitrates I B 753 758 Recommend HMG-CoA reductase inhibitor, cessation of tobacco use, and atherosclerosis risk factor modification I B 759 763 Recommend coronary angiography (invasive or noninvasive) for episodic chest pain with transient ST-elevation to detect severe CAD I C N/A Provocative testing during invasive coronary angiography* may be considered for suspected vasospastic angina when clinical criteria and noninvasive assessment fail to determine diagnosis IIb B 764 767 ACS with angiographically normal coronary arteries Invasive physiological assessment (coronary flow reserve measurement) may be considered with normal coronary arteries if endothelial dysfunction is suspected Stress (Takotsubo) cardiomyopathy Consider stress-induced cardiomyopathy in patients with apparent ACS and nonobstructive CAD I C N/A Perform ventriculography, echocardiography, or MRI to confirm or exclude diagnosis I B 795 798 Treat with conventional agents (ACE inhibitors, beta blockers, aspirin, and diuretics) if hemodynamically stable I C N/A Administer anticoagulant therapy for LV thrombi I C N/A It is reasonable to administer catecholamines for symptomatic hypotension in the absence of LV outflow tract obstruction IIa C N/A It is reasonable to use IABP for refractory shock IIa C N/A It is reasonable to use beta blockers and alpha-adrenergic agents for LV outflow tract obstruction IIa C N/A Prophylactic anticoagulation may be considered to prevent LV thrombi IIb C N/A *Provocative testing during invasive coronary angiography (eg, using ergonovine, acetylcholine, methylergonovine) is relatively safe, especially when performed in a controlled manner by experienced operators. 