Topic overview

Start with the big picture

The lesson surveys non-classical agents used to improve the balance between myocardial oxygen supply and demand. Ranolazine reduces late sodium current and is a second-line option for chronic stable angina; ivabradine lowers heart rate through selective inhibition of the SA-node funny current. Nicorandil combines potassium-channel opening with nitric oxide donation, while molsidomine provides nitric oxide activity. Trimetazidine and perhexiline alter myocardial substrate use, and high-dose allopurinol is discussed in relation to oxidative stress. The topic also covers rho-kinase inhibitors and capadenoson. Across these agents, the lesson connects mechanisms and indications with important limitations, adverse effects, interactions, and monitoring needs, supporting informed comparison rather than treating them as interchangeable alternatives.