Ranolazine, which was approved by the US Food and Drug Administration in January 2006, provides a mechanism of action to treat ischemia that has not hitherto been available. Ranolazine is effective in reducing manifestations of ischemia and angina, and it also holds potential promise to be effective in the management of left ventricular dysfunction, particularly diastolic dysfunction, and arrhythmias. This article provides an update on the available studies concerning the value of ranolazine across the spectrum of cardiovascular disease.