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Anti-Anginal Medications

Anti-Anginal Medications - CardioNerds

Anti-Anginal Medications

This infographic offers a structured overview of anti-anginal medications, their mechanisms, and recommended use according to ESC and NICE guidelines.

Classes and Mechanisms

Short-Acting Nitrates (e.g., Nitroglycerin)

    • Mechanism: Converts to NO for rapid vasodilation of peripheral and coronary arteries.
    • Use: Immediate relief for acute angina; ideal for PRN use.
    • Avoid in: Patients on PDE inhibitors (e.g., sildenafil) due to risk of severe hypotension.

    Long-Acting Nitrates (e.g., Isosorbide mono/dinitrate)

      • Mechanism: Sustained NO-mediated vasodilation.
      • Use: Beneficial for managing vasospastic angina and hypertension.
      • Avoid in: Risk of tachyphylaxis with prolonged use.

      Nicorandil

        • Mechanism: Activates K-channels and acts as a nitrate, improving coronary blood flow.
        • Use: Helps stabilize plaques, reducing future ACS risk.
        • Availability: Not available in the United States.

        Beta Blockers (e.g., Metoprolol, Carvedilol)

          • Mechanism: Reduces heart rate and myocardial oxygen demand.
          • Use: Ideal for patients with hypertension, HFrEF, or arrhythmias.
          • Avoid in: Patients with severe bradycardia, high-grade AV block, or bronchospasm.

          Non-DHP Calcium Channel Blockers (e.g., Verapamil, Diltiazem)

            • Mechanism: Reduces vascular tone and AV conduction by blocking calcium channels.
            • Use: Preferred in patients with vasospastic angina or migraine.
            • Avoid in: HFrEF or severe bradycardia.

            Ivabradine

              • Mechanism: Inhibits funny channels (If) to lower heart rate.
              • Use: Heart rate control in patients with HFrEF when beta-blockers are contraindicated.
              • Avoid in: Severe bradycardia or without HFrEF.

              DHP Calcium Channel Blockers (e.g., Amlodipine)

                • Mechanism: Vasodilates coronary and peripheral arteries.
                • Use: Effective in treating hypertension and vasospastic angina.

                Ranolazine

                  • Mechanism: Inhibits sodium-calcium exchange, reducing myocardial wall tension.
                  • Use: Relieves angina without affecting BP or HR.
                  • Avoid in: Patients with QT prolongation or multiple drug interactions.

                  Trimetazidine

                    • Mechanism: Improves metabolic efficiency by shifting energy substrate utilization.
                    • Use: Helpful for glycemic control in angina management.
                    • Avoid in: Parkinson’s disease due to contraindications.

                    ESC vs. NICE Guidelines

                    • ESC: Recommends beta-blockers and non-DHP calcium channel blockers as first-line treatments.
                    • NICE: Aligns with ESC but includes ivabradine for specific cases.

                    General Recommendations

                    • Encourage smoking cessation, statin therapy, exercise, and control of comorbidities such as HTN, DM, AF, and sleep apnea.

                    Created by Dr. Gambri Alan
                    Reviewed by Dr. Kate Alta Wilcox and Dr. Teodora Donisan

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