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051315153021
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Stable Unstabel Micro-
(Prinz-
Angina Angina vascular
metal's)
Chronic Acute
Coronary Coronary
Disease Disease (AHA, 2014; Aaronson et al,2000)
Stable • It occurs when the heart is working
harder than usual. S
Angina • Table angina has a regular pattern.
(Bashore et al , 2015)
ECG
Effects of increasing the heart
rate by atrial pacing in a patient
with typical stable angina.
Pacing stress caused a rapid
switch from lactate uptake to
lactate production,
a drop in the ST segment of
the electrocardiogram, and
chest pain.
Cessation of pacing resulted in
a rapid reversal from lactate
production back to net uptake,
elimination of pain, and a return
to a normal ST segment.
LVEDP, left ventricular end-
diastolic pressure
(Antman&Sabatine,2013)
Therapy Mechanism
(Antman&Sabatine,2013)
Therapy Mechanism
(Antman&Sabatine,2013)
Therapy Mechanism
(Antman&Sabatine,2013)
(Pappano &wier , 2013)
Two larger phase three studies have examined the efficacy
of sustained release ranolazine in patients with chronic
stable angina.
MARISA (Monotherapy Assessment of Ranolazine In
Stable Angina)
showed that ranolazine monotherapy significantly improved
exercise performance in patients with stable angina. This
was true for exercise duration, time to angina and time to 1
mm ST segment depression. More specifically, 70% of
patients in the placebo group stopped their exercise test
because of angina as compared to only 52% in the
ranolazine group (1.5 g bidaily).
Hasenfuss and Maier ,2007
CARISA (Combination Assessment of Ranolazine in
Stable Angina)
CARISA improved peak and trough exercise duration, time
to angina and time to 1 mm ST depression. These effects
were sustained through a 12-week treatment. Also
ranolazine reduced the number of angina attacks from a
baseline of 4.5 per week to 2.1 per week for ranolazine (1 g
bidaily) compared to 3.3 per week for placebo. Most
importantly, the anti-anginal effects of ranolazine in MARISA
and CARISA occurred without clinical meaningful changes
in heart rate or blood pressure
Talbert, R.L. 2008. Ischemic Heart Disease. In: Dipiro,J.T., Talbert,R.L., Yee,
G.C., Matzke, G.C., Wells,B.G., Posey, L.M. Pharmacotherapy:a
Pathophysiologic Approach 7th Ed. New York: McGraw-Hill Companies inc
References
Trujillo, T.C. and Nolan, P.E. 2013. Chronic Stable Angina. In: Alldredge,
B.K., Corelli,R.L., Guglielmo B.J., Jacobson, P.A.,Kradjan,
W.A.,Williams,B.R. (eds). Koda-Kimble & Young's Applied Therapeutics :
The Clinical Use of Drugs. Lippincott Williams & wilkins, Wolters Kluwer:
Philadelphia,USA