For a patient with angina symptoms unresponsive to typical treatments, which class of medication might be considered next?

Ranolazine is a unique antianginal agent that is particularly beneficial in patients who experience angina symptoms that do not respond adequately to conventional treatments such as nitrates or beta-blockers. It works by inhibiting the late sodium current in cardiac myocytes, which helps to reduce myocardial oxygen demand and improve exercise tolerance without significantly affecting heart rate or blood pressure.

In cases where traditional therapies fail to provide relief from angina, ranolazine can be an appropriate next step. It can be used as monotherapy or in combination with other antianginal agents. Its distinct mechanism allows it to be effective for patients who may not tolerate or respond well to the standard treatments for angina.

Nitrates are often first-line treatments for angina, but they may not be effective for all patients, particularly those with tolerance or other complications. Statins primarily target cholesterol levels and cardiovascular risk rather than acute relief of angina symptoms, and while they are essential in the management of coronary artery disease, they do not directly address angina management. ACE inhibitors, while beneficial for heart failure and hypertension, do not serve as acute antianginals and are typically used for long-term cardiovascular protection.

Therefore, considering a patient with persistent angina despite standard management, ran