Newer Antianginal Agents — Beyond the Hemodynamic Levers
Module 5 · Visual Summary
Two Non-Hemodynamic Mechanisms
Late Sodium Current Inhibitor
Ranolazine
- Blocks abnormal late sodium current during ischemia
- Breaks sodium-calcium overload cycle
- No effect on heart rate, blood pressure, contractility
- Main risk: corrected QT interval prolongation
Selective Funny Current Blocker
Ivabradine
- Slows sinus node depolarization
- Pure heart rate reduction only
- No effect on contractility or atrioventricular conduction
- Contraindicated in atrial fibrillation
Choosing Between Them
| Factor | Ranolazine | Ivabradine |
|---|
| Diabetes | Favored | No benefit |
| Atrial fibrillation | Appropriate | Contraindicated |
| Elevated heart rate on maximal beta-blocker | No rate benefit | Favored |
Other Non-Hemodynamic Agents
Not Available in the United States
Nicorandil: potassium channel opener with nitrate-like effect; risk of mucocutaneous ulceration. Trimetazidine: shifts cardiac metabolism toward more oxygen-efficient glucose use; risk of movement disorder symptoms.