Фармакотерапевтические возможности коррекции рефрактерной стенокардии

By decision of the European Society of Cardiology (ESC) and the American Heart Association (AHA), ranolazine is included in the treatment of stable angina. The drug is a selective inhibitor of late current sodium ions. By preventing intracellular overload with sodium ions and, accordingly, calcium ions, ranolazine helps to improve the diastolic relaxation of the myocardium. Due to this action, the disturbance of cardiomyocyte relaxation is eliminated, myocardial perfusion improves and myocardial ischemia decreases, which is clinically manifested by relief of angina pectoris: attacks become less common, exercise tolerance increases, the need for oral nitroglycerin decreases. Ranolazine does not influence on the main hemodynamic parameters – blood pressure and heart rate. Its allows, if necessary, to combine the drug with other drugs using in the treatment of ischemic heart disease. In case of angina pectoris, ranolazine is mainly used in combination with betaadrenoblockers, calcium channel blockers, and nitrates. A special category of patients is patients with refractory angina pectoris. Such patients have symptoms of the disease on the background of adequately selected pharmacotherapy and the inability to perform myocardial revascularization. The diagnosis of refractory angina can be made not only if the revascularization is denied, but also when angina is resumed after the intervention has already been performed. The results of clinical studies of ranolazine in patients with refractory angina are presents in this article. The clinical efficacy and safety of the inclusion of ranolazine in the treatment regimen of patients with refractory angina pectoris has been established. According to research, ranolazine is well tolerated and the most frequent side effects are dizziness, headache, constipation, nausea.