Ivabradine
Ivabradine, Nicorandil, Ranolazine, Trimetazidine are new generation of antianginal drugs .The mechanism of action, principal adverse effects and contraindications of each drug will be discussed.
Ivabradine:
Mechanism Of Action:
Ivabradine blocks the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel which is responsible for the cardiac pacemaker I(f) current. In clinical electrophysiology studies, the cardiac effects were most pronounced in the sinoatrial (SA) node, but prolongation of the AH interval has occurred on the surface ECG, as has PR interval prolongation
Principal Adverse Effects:
-Bradycardia
-First- degree heart block , very rarely second and third degree heart block
- Ventricular extra systoles and very rarely …show more content…
Preventive Services Task Force which had a negative opnion about recommending CAC screening of low risk for coronary events individuals , due to the lack of evidence notwithstanding the fact that discion is still not made concerning a routine screening of those with high risk for events . The expert-panel statement from Preventive Conference V, sponsored by the American Heart Association in 2000 had a smiliar opnion for not recommending the routine CAC assement but it noted that CAC screening would have the greatest potential value among asymptomatic patients with intermediate Framingham risk score.
ATP III GUIDELINES also does not recommend the CAC screening , however it pointed out that CAC scoring might be reasonable to consider for advanced risk assessment in appropriately selected individuals with multiple risk factors provided by a physician who has sufficient knowledge about non invasive testing.
In conclusion, wether a widespread coronary calcium screening will lead to an overall improvement in quality of care and clinical outcome or it would cause unnessecary further testing , radation exposure and anixity for the patients ,this will remain a major argument .Therefore this issue needs to be addressed in the future trials focusing more on the clinical outcomes and cost
Ivabradine:
Mechanism Of Action:
Ivabradine blocks the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel which is responsible for the cardiac pacemaker I(f) current. In clinical electrophysiology studies, the cardiac effects were most pronounced in the sinoatrial (SA) node, but prolongation of the AH interval has occurred on the surface ECG, as has PR interval prolongation
Principal Adverse Effects:
-Bradycardia
-First- degree heart block , very rarely second and third degree heart block
- Ventricular extra systoles and very rarely …show more content…
Preventive Services Task Force which had a negative opnion about recommending CAC screening of low risk for coronary events individuals , due to the lack of evidence notwithstanding the fact that discion is still not made concerning a routine screening of those with high risk for events . The expert-panel statement from Preventive Conference V, sponsored by the American Heart Association in 2000 had a smiliar opnion for not recommending the routine CAC assement but it noted that CAC screening would have the greatest potential value among asymptomatic patients with intermediate Framingham risk score.
ATP III GUIDELINES also does not recommend the CAC screening , however it pointed out that CAC scoring might be reasonable to consider for advanced risk assessment in appropriately selected individuals with multiple risk factors provided by a physician who has sufficient knowledge about non invasive testing.
In conclusion, wether a widespread coronary calcium screening will lead to an overall improvement in quality of care and clinical outcome or it would cause unnessecary further testing , radation exposure and anixity for the patients ,this will remain a major argument .Therefore this issue needs to be addressed in the future trials focusing more on the clinical outcomes and cost