Drug Selection and Combination Strategies
Module 6 · Visual Summary
Two Separate Goals
Anti-Ischemic
Symptom Control
- Nitrates, beta-blockers, calcium channel blockers
- Ranolazine, ivabradine
Mortality Reduction
Cardioprotection
- Aspirin, statins
- Beta-blockers post-infarction
Combination Escalation Pattern
Start
Beta-blocker (addresses two hemodynamic levers, often cardioprotective)
Add
Long-acting dihydropyridine calcium channel blocker (complementary, no additive conduction depression)
If Needed
Ranolazine or ivabradine (non-hemodynamic, no compounding bradycardia or hypotension)
Subtype-Specific Strategy
| Angina Subtype | First-Line | Avoid |
|---|
| Stable exertional | Beta-blocker | — |
| Vasospastic | Calcium channel blocker | Beta-blockers (all) |
| Microvascular | No single best agent | — |