Document:

THIS
      PROMISSORY NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
      AMENDED. NO SALE OR DISPOSITION MAY BE EFFECTED EXCEPT IN COMPLIANCE WITH RULE
      144 UNDER SAID ACT OR AN EFFECTIVE REGISTRATION STATEMENT RELATED THERETO OR
      AN
      OPINION OF COUNSEL FOR THE HOLDER SATISFACTORY TO THE COMPANY THAT SUCH
      REGISTRATION IS NOT REQUIRED UNDER THE ACT OR RECEIPT OF A NO-ACTION LETTER
      FROM
      THE SECURITIES AND EXCHANGE COMMISSION.

     

    PROMISSORY
      NOTE

    

    
      	
              $____________

            	
              October
                __, 2007

            

    

    

    FOR
      VALUE
      RECEIVED, EyeTel Imaging, Inc.,
      a
      Delaware corporation (“Payor”
or
      the
“Company”)
      promises to pay to [_______________]
      or
      its
      assigns (“Holder”)
      the
      principal sum of $[_________] with simple interest on the outstanding principal
      amount at the rate of 10.0% per annum. Interest shall commence with the date
      hereof and shall continue on the outstanding principal until paid in full.
      Interest shall be computed on the basis of a year of 365 days for the actual
      number of days elapsed.

     

    1. Payment.
      All
      payments of interest and principal shall be in lawful money of the United States
      of America. All payments shall be applied first to accrued interest, and
      thereafter to principal.

     

    2. Maturity.
      The
      entire outstanding principal balance and all unpaid accrued interest shall
      become fully due and payable upon the date (the “Maturity
      Date”)
      that
      is the earlier of:

     

    (a) the
      date
      that is five (5) business days after the closing date of an underwritten public
      offering pursuant to an effective registration statement under the Securities
      Act of 1933, as amended, covering the offer and sale of the Company’s common
      stock, par value $.001 per share (the “Common
      Stock”),
      for
      the account of the Company in which the aggregate gross proceeds to the Company
      equal or exceed $15,000,000 and after which the Common Stock is listed on the
      New York Stock Exchange, the Nasdaq Global Market or the American Stock
      Exchange, and 

     

    (b) March
      31,
      2008; provided
      that the
      principal balance and unpaid accrued interest shall not become fully due and
      payable pursuant to this clause (b) without the prior written consent of
      Lighthouse Capital Partners V, L.P. (“Lighthouse”)
      as
      long as and to the extent that any obligations remain outstanding on the part
      of
      the Company in connection with the Loan and Security Agreement, dated as of
      February 8, 2006, between the Company and Lighthouse, as amended to date and
      as
      may be amended from time to time in the future (the “Lighthouse
      Loan Agreement”);
      and
provided
      further
      that, in
      the event Lighthouse does not provided such written consent, the principal
      balance and unpaid accrued interest shall become fully due and payable upon
      the
      earlier of the date on which Lighthouse delivers such written consent and the
      date immediately after the date on which all such outstanding obligations under
      the Lighthouse Loan Agreement are discharged in full.

     

    3. Events
      of Default.
      If
      there shall be any Event of Default hereunder, at the option and upon the
      declaration of the Holder and upon written notice to the Payor (which election
      and notice shall not be required in the case of an Event of Default under
      Section 3(b)
      or
3(c)),
      this
      Note shall accelerate and all principal and unpaid accrued interest shall become
      due and payable. The occurrence of any one or more of the following shall
      constitute an Event of Default:

     

    (a) Payor
      fails to pay timely any of the principal amount due under this Note on the
      date
      the same becomes due and payable or any accrued interest or other amounts due
      under this Note on the date the same becomes due and payable;

     

    (b) Payor
      files any petition or action for relief under any bankruptcy, reorganization,
      insolvency or moratorium law or any other law for the relief of, or relating
      to,
      debtors, now or hereafter in effect, or makes any assignment for the benefit
      of
      creditors or takes any corporate action in furtherance of any of the foregoing;
      or

     

    
      
         

      

      
        -1-

        
          

        

      

      
         

      

    

     

    (c) An
      involuntary petition is filed against Payor (unless such petition is dismissed
      or discharged within sixty (60) days) under any bankruptcy statute now or
      hereafter in effect, or a custodian, receiver, trustee, assignee for the benefit
      of creditors (or other similar official) is appointed to take possession,
      custody or control of any property of Payor.

     

    4. Subordination.
      The
      right of payment of the indebtedness evidenced by this Note pursuant only to
      Section 3
      hereof
      is subordinated to the prior payment in full of all obligations outstanding
      on
      the part of the Company pursuant to the Lighthouse Loan Agreement. Any
      funds
      received by Holder in contravention of this Section 4
      shall be
      held by Holder in trust for Lighthouse. Lighthouse is an express third party
      beneficiary of this clause, entitled to enforce it against Payor and
      Holder.

     

    5. Waiver
      of Demand.
      Payor
      hereby waives demand, notice, presentment, protest and notice of
      dishonor.

     

    6. Governing
      Law.
      This
      Note shall be governed by and construed under the laws of the State of New
      York
      as such laws are applied to agreements among New York residents entered into
      and
      performed entirely within the State of New York, without reference to the
      conflict of laws provisions thereof. 

     

    7. Notices.
      All
      notices and other communications provided for herein shall be in writing and
      shall be deemed to have been duly given, delivered and received: (a) upon
      personal delivery to the party to be notified, (b) when sent by confirmed
      telex, electronic mail or facsimile if sent during normal business hours of
      the
      recipient, if not, then on the next business day, (c) five (5) days after
      having been sent by registered or certified mail, return receipt requested,
      postage prepaid, or (d) one (1) day after deposit with a nationally
      recognized overnight courier, specifying next day delivery, with written
      verification of receipt. 

     

    (a) If
      to
      Holder:

     

    [______________________

    _______________________

    _______________________

    _______________________]

     

    
      
         

      

      
        -2-

        
          

        

      

      
         

      

    

    

     

    (b) If
      to the
      Company:

     

    EyeTel
      Imaging, Inc.

    9130
      Guilford Road

    Columbia,
      MD 21046

    Attention:
      Keith G. Frey

     

    8. Amendment
      and Waiver.
      Any
      term of this Note may be amended or waived with the written consent of Payor,
      the Holder and, with respect to Section 4
      hereof,
      Lighthouse.

     

    

    [Signature
      Page Follows]

     

    
      
         

      

      
        -3-

        
          

        

      

      
         

      

    

     

     

    IN
      WITNESS WHEREOF,
      the
      Company has caused this Note to be signed the date above written. 

    
 

    
      	
              EYETEL
                IMAGING, INC.

               

              By:
                ___________________________________

              Name:
                John C. Garbarino

              Title:
                President and Chief Executive
                Officer

            

    

    
      

    Accepted
      and Agreed:

    

    [_______________]

    

    

    By:
      __________________________________

    Name:

    Title:

     

    
      
         

      

      
        -4-DC2630.pdf -- Converted by SEC Publisher 4.2, created by BCL Technologies Inc., for SEC Filing

     THIS INSTRUMENT OF RESIGNATION, APPOINTMENT AND ACCEPTANCE (this “Instrument”), dated as of September 18, 2007 (“Effective Date”), is by and among
CV Therapeutics, Inc., a corporation duly organized and existing under the laws of the State of Delaware (the “Company”), US Bank National
Association, a national banking association duly organized and existing under the laws of the United States (the “Successor Trustee” and “Successor Escrow Agent”), and Wells Fargo Bank, National Association,  a national banking association duly organized and existing under the laws of the United States (the “Resigning Trustee” and “Resigning Escrow
Agent”). Capitalized terms not otherwise defined herein shall have the same meaning ascribed to such terms in the Indentures (as defined below) as applicable.

	
RECITALS

     WHEREAS, pursuant to an indenture dated as of June 18, 2003 (the “2003 Indenture”), by and between the Company and the Resigning Trustee, the Company issued the aggregate principal amount of
$100,000,000 of its 2% Senior Subordinated Convertible Debentures due 2023 (the “2003 Debentures”);

     WHEREAS, pursuant to an indenture dated as of May 18, 2004 (the “2004 Indenture”), by and between the Company and the Resigning Trustee, the Company issued the aggregate principal amount of
$150,000,000 of its 2.75% Senior Subordinated Convertible Notes due 2012 (the “2004 Notes”);

     WHEREAS, pursuant to an indenture dated as of July 1, 2005 (the “2005 Indenture”, and collectively with the 2003 Indenture and the 2004 Indenture, the “Indentures”), by and between
the Company and the Resigning Trustee, the Company issued the aggregate principal amount of $149,500,000 of its 3.25% Senior Subordinated Convertible Notes due 2013 (the “2005 Notes”, and collectively with the 2003 Debentures and the
2004 Notes, the “Notes”);

     WHEREAS, pursuant to a pledge and escrow agreement dated as of July 1, 2005 (the “Pledge Agreement”), by and among the Company, the Resigning Trustee, and Wells Fargo Bank, National
Association, in its capacity as escrow agent (the “Escrow Agent”), the Escrow Agent is holding the Government Securities (as defined therein) identified on Schedule 1 annexed
hereto;

     WHEREAS, the Company appointed the Resigning Trustee as the Paying Agent and Registrar under each of the Indentures;

     WHEREAS, there is presently issued and outstanding: (i) $100,000,000 in aggregate principal amount of the 2003 Debentures; (ii) $150,000,000 in aggregate principal amount of the 2004 Notes;
and (iii) $149,500,000 in aggregate principal amount of the 2005 Notes;

1

     WHEREAS, Section 5.9 of each of the Indentures provides that the Trustee may at any time resign by giving written notice of such resignation to the Company and the Company shall promptly appoint a
successor Trustee;

     WHEREAS, Section 11 of the Pledge Agreement provides that the Escrow Agent may resign upon 30 days’ written notice to the Company and the Trustee and the Company shall appoint a successor Escrow
Agent;

     WHEREAS, the Resigning Trustee desires to resign as Trustee, Paying Agent and Registrar and the Company desires to appoint the Successor Trustee as Trustee, Paying Agent and Registrar to succeed the
Resigning Trustee under each of the Indentures; and

     WHEREAS, the Successor Trustee is willing to accept the appointment as Trustee, Paying Agent and Registrar under each of the Indentures;

     WHEREAS, the Resigning Escrow Agent desires to resign as Escrow Agent and the Company desires to appoint the Successor Escrow Agent as Escrow Agent to succeed the Resigning Escrow Agent under the
Pledge Agreement;

     WHEREAS, the Successor Escrow Agent is willing to accept the appointment as Escrow Agent under the Pledge Agreement;

     NOW, THEREFORE, in consideration of the covenants herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as
follows:

     1. Acceptance of Resignation of Resigning Trustee and Resigning Escrow Agent; Appointment of Successor Trustee and Successor Escrow
Agent. Pursuant to Section 5.9 of each of the Indentures, the Resigning Trustee hereby resigns as Trustee under the Indentures. The Resigning Trustee also hereby resigns
as Paying Agent and Registrar under each of the Indentures.  The Company accepts the resignation of the Resigning Trustee as Trustee, Paying Agent and Registrar and hereby appoints the Successor Trustee as Trustee, Paying Agent and Registrar under
each of the Indentures. Pursuant to Section 11 of the Pledge Agreement, the Resigning Escrow Agent hereby resigns as Escrow Agent under the Pledge Agreement.  The Company accepts the resignation of the Resigning Escrow Agent and hereby appoints the
Successor Escrow Agent as Escrow Agent under the Pledge Agreement.

     2. Company Representations and Warranties. The Company represents and warrants to the
Successor Trustee that:

	
a.      		
It is duly incorporated and validly existing;	
	 
	
b.      		
The execution and delivery of this Instrument have been duly authorized	
	 

	 	
by the Company;

2

	
c.      		
[reserved]	
	 
	
d.      		
No Event of Default and no other event which, after notice or lapse of	
	 

time or both, would become an Event of Default, has occurred and is continuing under any of the Indentures;

	
e.      		
Each of the Indentures is in full force and effect;	
	 
	
f.      		
There is no action, suit or proceedings pending or, to the best of the	
	 

Company’s knowledge, threatened against the Company before any court or any government authority arising out of any action or omission by the Company under any of the Indentures; and

g. This Instrument has been duly authorized, executed and delivered on behalf of the Company and, assuming due authorization, execution and delivery by the Successor Trustee, the Successor Escrow Agent, the Resigning Trustee and
the Resigning Escrow Agent, constitutes its legal, valid and binding obligation.

     3. Resigning Trustee Representations and Warranties.  The Resigning Trustee hereby
represents and warrants to the Successor Trustee that:

a. No covenant or condition contained in any of the Indentures has been waived by the Resigning Trustee or, to the best of the knowledge of the Resigning Trustee, by the Holders of the percentage in aggregate principal amount of
the Notes required by each of the Indentures to effect any such waiver; 

b. There is no action, suit or proceeding pending or, to the best of the knowledge of the Resigning Trustee, threatened against the Resigning Trustee before any court or governmental authority arising out of any action or omission
by the Resigning Trustee as Trustee, Paying Agent and Registrar under any of the Indentures;

c. Resigning Trustee has delivered or will deliver to Successor Trustee, as of or immediately after the Effective Date hereof, all documents in its possession relating to the trusts created under the Indentures, including all of
the documents listed in Exhibit B hereto, and such other documents reasonably requested by the Company, the Successor Trustee or the Successor Escrow Agent;

d. The execution and delivery of this Instrument have been duly authorized by the Resigning Trustee, and this Instrument constitutes the Resigning Trustee’s legal, valid, binding and enforceable obligation; and

e. The Resigning Trustee certifies that: (i) $100,000,000 in aggregate principal amount of the 2003 Debentures is outstanding and interest has been paid through May 15, 2007; (ii) $150,000,000 in aggregate principal amount
of the 2004 Notes is outstanding and interest has been paid through May 15, 2007; and

3

(iii) $149,500,000 in aggregate principal amount of the 2005 Notes is outstanding and interest has been paid through August 15, 2007.

     4. Successor Trustee Representations and Warranties.  The Successor Trustee represents
and warrants to the Resigning Trustee and the Company that:

     a. It is eligible to serve as Trustee under each of the Indentures pursuant to the eligibility requirements set forth therein and the Trust Indenture Act of 1939; and b. It is eligible to serve as
Escrow Agent under the Pledge Agreement pursuant to the eligibility requirements set forth therein.

     5. Acceptance by Successor Trustee and Successor Escrow Agent. Pursuant to Section 5.9
of each of the Indentures, the Successor Trustee hereby accepts its appointment as Trustee under each of the Indentures and shall hereby be vested with all the rights, powers, trusts and duties of the Trustee under each of the Indentures and with
respect to all property and money held or to be held under each of the Indentures, with like effect as if the Successor Trustee was originally named as Trustee under each of the Indentures. The Successor Trustee also hereby accepts it appointment as
Registrar and Paying Agent. The Successor Trustee will perform said rights, powers and duties upon the terms and conditions set forth in each of the Indentures. Promptly after the execution and delivery of this Instrument, the Successor Trustee
shall cause a notice, a form of which is annexed hereto as Exhibit A, to be sent to each Holder of the Notes. Pursuant to Section 11 of the Pledge Agreement, the Successor Escrow Agent
hereby accepts its appointment as Escrow Agent under the Pledge Agreement and shall be hereby vested with all the rights, powers, trusts and duties of the Escrow Agent under the Pledge Agreement and with respect to all property and money held or to
be held under the Pledge Agreement, with like effect as if the Successor Escrow Agent was originally named as Escrow Agent under the Pledge Agreement.

     6. Board Resolution. The Company hereby certifies that Exhibit C
annexed hereto is true and correct copy of the board resolution that was duly adopted by the Board of Directors of the Company authorizing the appointment of the Successor Trustee and the Successor Escrow Agent.

     7. Assignment etc. by Resigning Trustee. Effective on the Effective Date, the Resigning
Trustee hereby confirms, assigns, transfers, delivers and conveys to the Successor Trustee, as Trustee under each of the Indentures, upon the trusts expressed in the Indentures, all rights, powers, trusts, privileges, duties and obligations which
the Resigning Trustee now holds under and by virtue of each of the Indentures, and effective as of such date does hereby pay over to the Successor Trustee any and all property and moneys held by the Resigning Trustee under and by virtue of each of
the Indentures.

     8. Additional Documentation.  The Resigning Trustee, the Resigning Escrow Agent and the
Company, for the purposes of more fully and certainly vesting in and confirming to the Successor Trustee and the Successor Escrow Agent the rights, powers, trusts, privileges, duties and obligations hereby assigned, transferred, delivered and
conveyed, agree, upon reasonable request of the Successor Trustee or the Successor

4

Escrow Agent, to execute, acknowledge and deliver such further instruments of conveyance and further assurance and to do such other things as may reasonably be required by the Successor Trustee or the Successor Escrow
Agent.

     9. Choice of Laws. This Instrument shall be governed by the same laws that govern each
of the Indentures.

     10. Counterparts.  This Instrument may be executed in any number of counterparts, each
of which, when so executed and delivered, shall be an original, but all counterparts shall constitute but one Instrument.

     11. Survival of Company’s Obligations to Resigning Trustee and Resigning Escrow Agent.  Notwithstanding the resignation of the Resigning Trustee as Trustee under each of the Indentures, the Company shall remain obligated under each of the Indentures to compensate, reimburse and indemnify the Resigning Trustee in
connection with its services as Trustee as provided in each of the Indentures, and nothing contained in this Instrument shall in any way abrogate the obligations of the Company to the Resigning Trustee under each of the Indentures or any lien
created in favor of the Resigning Trustee thereunder.  The Company also acknowledges and reaffirms its obligation to the Successor Trustee set forth in Section 5.8 of each of the Indentures. Notwithstanding the resignation of the Resigning Escrow
Agent as Escrow Agent under the Pledge Agreement, the Company shall remain obligated under the Pledge Agreement to compensate, reimburse and indemnify the Resigning Escrow Agent in connection with its services as Escrow Agent as provided in the
Pledge Agreement, and nothing contained in this Instrument shall in any way abrogate the obligations of the Company to the Resigning Escrow Agent under the Pledge Agreement or any lien created in favor of the Resigning Escrow Agent thereunder. The
Company also acknowledges and reaffirms its obligation to the Successor Escrow Agent set forth in Sections 9 and 10 of the Pledge Agreement.

     12. Notices. All notices, whether faxed or mailed, will be deemed received when sent
pursuant to the following instructions:

TO THE SUCCESSOR TRUSTEE/SUCCESSOR ESCROW AGENT:

	 	
US Bank National Association

60 Livingston Avenue

EP-MN-WS3C

St. Paul, MN 55107-2292

Attn: Rick Prokosch 

Phone: 651-495-3918

Fax: 651-495-8097

5

TO THE RESIGNING TRUSTEE/RESIGNING ESCROW AGENT:

	 	
Wells Fargo Bank, N.A.

Corporate Trust Services

625 Marquette Avenue; N9311-110

Minneapolis, MN 55479

Attn: Tim Mowdy

Phone: 612-316-1445

Fax: 612-667-9825

	
TO THE COMPANY:

	 	
CV Therapeutics, Inc.

Attn: General Counsel

3172 Porter Drive

Palo Alto, CA 94304

Fax: 650-858-0388

With a copy (which shall not constitute notice) to:

	 	
Latham & Watkins LLP

140 Scott Drive

Menlo Park, CA 94025

Fax: 650-463-2600

Attn: Alan C. Mendelson, Esq.

     13. Effectiveness.  This Instrument and the resignation, appointment and acceptance
effected hereby shall be effective as of the close of business on the Effective Date; provided, that the resignation of the Resigning Trustee as Paying Agent and the appointment of the
Successor Trustee as Paying Agent under each of the Indentures shall be effective 10 days after the date first above written.

	
[Remainder of page intentionally left blank]

6

     IN WITNESS WHEREOF, the parties hereto have executed this Instrument as of the date set forth above.

	
CV Therapeutics, Inc., as the Company

By_/s/ Louis G. Lange, M.D., Ph.D.

Its_Chairman & CEO

US Bank National Association, as the Successor Trustee and Successor Escrow Agent

	
By_/s/ Richard Prokosch

Its_Vice President

Wells Fargo Bank, National Association, as the Resigning Trustee and Resigning Escrow Agent

	
By_/s/ Timothy P. Mowdy

Its_Vice President

7

	
EXHIBIT A

Notice to Holders of CV Therapeutics, Inc. [insert title of securities]:

We hereby notify you of the resignation of Wells Fargo Bank, National Association, as Trustee under the Indenture, [insert date of Indenture] pursuant to which your Notes were issued and are outstanding.

CV Therapeutics, Inc. has appointed US Bank National Association, whose Corporate Trust Office is located at 60 Livingston Avenue, EP-MN-WS3C, St. Paul, MN 55107-2292, as successor Trustee under the Indenture, which appointment
has been accepted and become effective.

	
EXHIBIT B

     Documents to be delivered by Resigning Trustee to Successor Trustee as to each of the Indentures (except where noted):

     1. Copy of the most recent of each of the SEC reports delivered by the Company pursuant to each of the Indentures.

	
2.      		
Copy of Indentures.	
	 
	
3.      		
File of Closing Documents.	
	 
	
4.      		
U.S. Treasury Strips held under the Pledge Agreement and identified on Schedule 1	
	 

	
annexed hereto.

     5. Copy of the most recent Compliance Certificate delivered pursuant to each of the Indentures.

     6. Certified lists of Noteholders as of the Effective Date, certificate detail and all “stop transfers” and the reason for such “stop transfers” (or, alternatively, if there are a
substantial number of registered Noteholders, the computer tape reflecting the identity of such Noteholders).

     7. Copies of any official notices sent by the Trustee to all the Noteholders of the Notes pursuant to the terms of the Indentures during the past twelve months, if any.

	
8.      		
Notes debt service records.	
	 
	
9.      		
Trust account statements for one-year period proceeding the date of this Instrument.	
	 
	
10.      		
All unissued Note inventory, if any or DTC FAST held global certificates.	
	 
	
11.      		
[reserved]	
	 

	
EXHIBIT C

	
EXHIBIT

	
To the Minutes of the September 12-13, 2007

Regular Meeting of the Board of Directors

of CV Therapeutics, Inc.

APPOINTMENT OF SUCCESSOR TRUSTEE FOR CONVERTIBLE NOTES

     WHEREAS, the Board of Directors (the “Board of Directors”) of CV Therapeutics, Inc., a Delaware corporation (the “Company”), has previously
authorized and approved the issuance of the aggregate principal amount of $100,000,000 of its 2% Senior Subordinated Convertible Debentures due 2023 (the “2003 Debentures”) pursuant to an indenture dated as of June 18, 2003 (the “2003 Indenture”), by and between the Company and Wells Fargo Bank, National Association,
a national banking association duly organized and existing under the laws of the United States (“Wells Fargo”); WHEREAS, the Board of Directors of the Company has previously authorized and approved the issuance of the aggregate
principal amount of $150,000,000 of its 2.75% Senior Subordinated Convertible Notes due 2012 (the “2004 Notes”) pursuant to an indenture dated as of May 18, 2004
(the “2004 Indenture”), by and between the Company and Wells Fargo; WHEREAS, the Board of Directors of the Company has previously authorized and approved the issuance of the aggregate principal amount of $149,500,000 of its
3.25% Senior Subordinated Convertible Notes due 2013 (the “2005 Notes,” and collectively with the 2003 Debentures and the 2004 Notes, the “Notes”) pursuant to an indenture dated as of July 1, 2005 (the “2005 Indenture,” and collectively with the 2003
Indenture and the 2004 Indenture, the “Indentures”), by and between the Company and Wells Fargo; WHEREAS, the Company appointed Wells Fargo as the paying agent (“Paying Agent”) and registrar (“Registrar”) under each of the Indentures;

     WHEREAS, Wells Fargo has also acted as escrow agent
(“Escrow Agent”) pursuant to a pledge and escrow agreement dated as of July 1, 2005 (the “Pledge Agreement”), by and among the Company, Wells Fargo, as Trustee, and Wells Fargo, in its capacity as Escrow Agent; WHEREAS, Wells Fargo desires to resign as Trustee, Paying Agent and Registrar and the Company desires to appoint US Bank National Association, a national banking association duly organized and existing
under the laws of the United States (“US Bank”), as Trustee, Paying Agent and Registrar to succeed Wells Fargo under each of the Indentures; and WHEREAS, Wells Fargo desires to resign as Escrow Agent and the Company desires to appoint US Bank as Escrow
Agent to succeed Wells Fargo as Escrow Agent under the Pledge Agreement; NOW, THEREFORE, BE IT RESOLVED, that the officers of the Company be, and each of them acting alone hereby is, authorized and empowered in the name and on behalf of the
Company, to designate and appoint (i) US Bank as Trustee, Paying Agent and Registrar to succeed Wells Fargo under the Indentures and (ii) US Bank as Escrow Agent to succeed Wells Fargo as Escrow Agent under the Pledge Agreement; RESOLVED FURTHER, that the
officers of the Company be, and each of them acting alone hereby is, authorized and empowered in the name and on behalf of the Company to enter into the Instrument of Resignation, Appointment and Acceptance, by and among the Company, US Bank and
Wells Fargo, in substantially the form attached hereto as Exhibit “-“-I, with such changes to such instrument as such officers or officer shall determine in their
discretion to be necessary, appropriate or desirable, the execution thereof to be evidence of such determination, and all such other agreements as may be necessary, appropriate or advisable in order to effectuate the foregoing designation and
appointment; RESOLVED FURTHER, that such specific additional resolutions as may be (i) required to be adopted by US Bank as Trustee in connection with the appointment of US Bank as Trustee for the Notes and the performance by US Bank of its duties as such and (ii)
approved by the officers of the Company or any of them, are hereby adopted; and

11

     RESOLVED FURTHER, that the officers of the Company be, and each of them acting alone hereby is, authorized and empowered in the name and on behalf of the Company to appoint US Bank (or such other person as may be
approved by such officer or officers) as Paying Agent and Registrar for the Notes, and to appoint US Bank as Trustee (or such other person as may be approved by such officer or officers) as Agent of the Company for the payment of the principal of
and interest on the Notes, and for the purpose of registering any Notes, and transferring or discharging from registration any Notes, pursuant to the Indentures.

GENERAL AUTHORITY AND RATIFICATION OF CONSISTENT ACTIONS

     RESOLVED, that any and all actions taken and documents executed by the
officers of the Company, or any person or persons designated and authorized to act by any of them, prior to the adoption of these resolutions which would have been authorized thereby had such actions been taken (or documents been executed) after
adoption of these resolutions, are hereby ratified, confirmed, approved and adopted in all respects; and RESOLVED FURTHER, that the officers of the Company be, and each of them hereby is, authorized and directed, in the name and on
behalf of the Company, to do or cause to be done all such acts or things and to sign and deliver, or cause to be signed and delivered, all such documents, instruments and certificates, as such officer or officers may deem necessary, advisable or
appropriate to effectuate or carry out the purposes and intent of the foregoing resolutions and to perform the obligations of the Company under the agreements and instruments referred to therein, the execution and delivery of such documents,
instruments and certificates and the taking of any such action to be conclusive evidence of the due authorization thereof by the Company.

12

	
EXECUTION VERSION

	
Exhibit “-“-1

Form of Instrument of Resignation, Appointment and Acceptance

     THIS INSTRUMENT OF RESIGNATION, APPOINTMENT AND ACCEPTANCE (this “Instrument”), dated as of September 18, 2007 (“Effective Date”), is by and among
CV Therapeutics, Inc., a corporation duly organized and existing under the laws of the State of Delaware (the “Company”), US Bank National
Association, a national banking association duly organized and existing under the laws of the United States (the “Successor Trustee” and “Successor Escrow Agent”), and Wells Fargo Bank, National Association,  a national banking association duly organized and existing under the laws of the United States (the “Resigning Trustee” and “Resigning Escrow
Agent”). Capitalized terms not otherwise defined herein shall have the same meaning ascribed to such terms in the Indentures (as defined below) as applicable.

	
RECITALS

     WHEREAS, pursuant to an indenture dated as of June 18, 2003 (the “2003 Indenture”), by and between the Company and the Resigning Trustee, the Company issued the aggregate principal amount of
$100,000,000 of its 2% Senior Subordinated Convertible Debentures due 2023 (the “2003 Debentures”);

     WHEREAS, pursuant to an indenture dated as of May 18, 2004 (the “2004 Indenture”), by and between the Company and the Resigning Trustee, the Company issued the aggregate principal amount of
$150,000,000 of its 2.75% Senior Subordinated Convertible Notes due 2012 (the “2004 Notes”);

     WHEREAS, pursuant to an indenture dated as of July 1, 2005 (the “2005 Indenture”, and collectively with the 2003 Indenture and the 2004 Indenture, the “Indentures”), by and between
the Company and the Resigning Trustee, the Company issued the aggregate principal amount of $149,500,000 of its 3.25% Senior Subordinated Convertible Notes due 2013 (the “2005 Notes”, and collectively with the 2003 Debentures and the
2004 Notes, the “Notes”);

     WHEREAS, pursuant to a pledge and escrow agreement dated as of July 1, 2005 (the “Pledge Agreement”), by and among the Company, the Resigning Trustee, and Wells Fargo Bank, National
Association, in its capacity as escrow agent (the “Escrow Agent”), the Escrow Agent is holding the Government Securities (as defined therein) identified on Schedule 1 annexed
hereto;

     WHEREAS, the Company appointed the Resigning Trustee as the Paying Agent and Registrar under each of the Indentures;

     WHEREAS, there is presently issued and outstanding: (i) $100,000,000 in aggregate principal amount of the 2003 Debentures; (ii) $150,000,000 in aggregate principal amount of the 2004 Notes;
and (iii) $149,500,000 in aggregate principal amount of the 2005 Notes;

14

     WHEREAS, Section 5.9 of each of the Indentures provides that the Trustee may at any time resign by giving written notice of such resignation to the Company and the Company shall promptly appoint a
successor Trustee;

     WHEREAS, Section 11 of the Pledge Agreement provides that the Escrow Agent may resign upon 30 days’ written notice to the Company and the Trustee and the Company shall appoint a successor Escrow
Agent;

     WHEREAS, the Resigning Trustee desires to resign as Trustee, Paying Agent and Registrar and the Company desires to appoint the Successor Trustee as Trustee, Paying Agent and Registrar to succeed the
Resigning Trustee under each of the Indentures; and

     WHEREAS, the Successor Trustee is willing to accept the appointment as Trustee, Paying Agent and Registrar under each of the Indentures;

     WHEREAS, the Resigning Escrow Agent desires to resign as Escrow Agent and the Company desires to appoint the Successor Escrow Agent as Escrow Agent to succeed the Resigning Escrow Agent under the
Pledge Agreement;

     WHEREAS, the Successor Escrow Agent is willing to accept the appointment as Escrow Agent under the Pledge Agreement;

     NOW, THEREFORE, in consideration of the covenants herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as
follows:

     2. Acceptance of Resignation of Resigning Trustee and Resigning Escrow Agent; Appointment of Successor Trustee and Successor Escrow
Agent. Pursuant to Section 5.9 of each of the Indentures, the Resigning Trustee hereby resigns as Trustee under the Indentures. The Resigning Trustee also hereby resigns
as Paying Agent and Registrar under each of the Indentures.  The Company accepts the resignation of the Resigning Trustee as Trustee, Paying Agent and Registrar and hereby appoints the Successor Trustee as Trustee, Paying Agent and Registrar under
each of the Indentures. Pursuant to Section 11 of the Pledge Agreement, the Resigning Escrow Agent hereby resigns as Escrow Agent under the Pledge Agreement.  The Company accepts the resignation of the Resigning Escrow Agent and hereby appoints the
Successor Escrow Agent as Escrow Agent under the Pledge Agreement.

     2. Company Representations and Warranties. The Company represents and warrants to the
Successor Trustee that:

	
a.      		
It is duly incorporated and validly existing;	
	 
	
b.      		
The execution and delivery of this Instrument have been duly authorized	
	 

	 	
by the Company;

15

	
c.      		
[reserved]	
	 
	
d.      		
No Event of Default and no other event which, after notice or lapse of	
	 

time or both, would become an Event of Default, has occurred and is continuing under any of the Indentures;

	
e.      		
Each of the Indentures is in full force and effect;	
	 
	
f.      		
There is no action, suit or proceedings pending or, to the best of the	
	 

Company’s knowledge, threatened against the Company before any court or any government authority arising out of any action or omission by the Company under any of the Indentures; and

g. This Instrument has been duly authorized, executed and delivered on behalf of the Company and, assuming due authorization, execution and delivery by the Successor Trustee, the Successor Escrow Agent, the Resigning Trustee and
the Resigning Escrow Agent, constitutes its legal, valid and binding obligation.

     3. Resigning Trustee Representations and Warranties.  The Resigning Trustee hereby
represents and warrants to the Successor Trustee that:

a. No covenant or condition contained in any of the Indentures has been waived by the Resigning Trustee or, to the best of the knowledge of the Resigning Trustee, by the Holders of the percentage in aggregate principal amount of
the Notes required by each of the Indentures to effect any such waiver; 

b. There is no action, suit or proceeding pending or, to the best of the knowledge of the Resigning Trustee, threatened against the Resigning Trustee before any court or governmental authority arising out of any action or omission
by the Resigning Trustee as Trustee, Paying Agent and Registrar under any of the Indentures;

c. Resigning Trustee has delivered or will deliver to Successor Trustee, as of or immediately after the Effective Date hereof, all documents in its possession relating to the trusts created under the Indentures, including all of
the documents listed in Exhibit B hereto, and such other documents reasonably requested by the Company, the Successor Trustee or the Successor Escrow Agent;

d. The execution and delivery of this Instrument have been duly authorized by the Resigning Trustee, and this Instrument constitutes the Resigning Trustee’s legal, valid, binding and enforceable obligation; and

e. The Resigning Trustee certifies that: (i) $100,000,000 in aggregate principal amount of the 2003 Debentures is outstanding and interest has been paid through May 15, 2007; (ii) $150,000,000 in aggregate principal amount
of the 2004 Notes is outstanding and interest has been paid through May 15, 2007; and

16

(iii) $149,500,000 in aggregate principal amount of the 2005 Notes is outstanding and interest has been paid through August 15, 2007.

     4. Successor Trustee Representations and Warranties.  The Successor Trustee represents
and warrants to the Resigning Trustee and the Company that:

     a. It is eligible to serve as Trustee under each of the Indentures pursuant to the eligibility requirements set forth therein and the Trust Indenture Act of 1939; and b. It is eligible to serve as
Escrow Agent under the Pledge Agreement pursuant to the eligibility requirements set forth therein.

     5. Acceptance by Successor Trustee and Successor Escrow Agent. Pursuant to Section 5.9
of each of the Indentures, the Successor Trustee hereby accepts its appointment as Trustee under each of the Indentures and shall hereby be vested with all the rights, powers, trusts and duties of the Trustee under each of the Indentures and with
respect to all property and money held or to be held under each of the Indentures, with like effect as if the Successor Trustee was originally named as Trustee under each of the Indentures. The Successor Trustee also hereby accepts it appointment as
Registrar and Paying Agent. The Successor Trustee will perform said rights, powers and duties upon the terms and conditions set forth in each of the Indentures. Promptly after the execution and delivery of this Instrument, the Successor Trustee
shall cause a notice, a form of which is annexed hereto as Exhibit A, to be sent to each Holder of the Notes. Pursuant to Section 11 of the Pledge Agreement, the Successor Escrow Agent
hereby accepts its appointment as Escrow Agent under the Pledge Agreement and shall be hereby vested with all the rights, powers, trusts and duties of the Escrow Agent under the Pledge Agreement and with respect to all property and money held or to
be held under the Pledge Agreement, with like effect as if the Successor Escrow Agent was originally named as Escrow Agent under the Pledge Agreement.

     6. Board Resolution. The Company hereby certifies that Exhibit C
annexed hereto is true and correct copy of the board resolution that was duly adopted by the Board of Directors of the Company authorizing the appointment of the Successor Trustee and the Successor Escrow Agent.

     7. Assignment etc. by Resigning Trustee. Effective on the Effective Date, the Resigning
Trustee hereby confirms, assigns, transfers, delivers and conveys to the Successor Trustee, as Trustee under each of the Indentures, upon the trusts expressed in the Indentures, all rights, powers, trusts, privileges, duties and obligations which
the Resigning Trustee now holds under and by virtue of each of the Indentures, and effective as of such date does hereby pay over to the Successor Trustee any and all property and moneys held by the Resigning Trustee under and by virtue of each of
the Indentures.

     8. Additional Documentation.  The Resigning Trustee, the Resigning Escrow Agent and the
Company, for the purposes of more fully and certainly vesting in and confirming to the Successor Trustee and the Successor Escrow Agent the rights, powers, trusts, privileges, duties and obligations hereby assigned, transferred, delivered and
conveyed, agree, upon reasonable request of the Successor Trustee or the Successor

17

Escrow Agent, to execute, acknowledge and deliver such further instruments of conveyance and further assurance and to do such other things as may reasonably be required by the Successor Trustee or the Successor Escrow
Agent.

     9. Choice of Laws. This Instrument shall be governed by the same laws that govern each
of the Indentures.

     10. Counterparts.  This Instrument may be executed in any number of counterparts, each
of which, when so executed and delivered, shall be an original, but all counterparts shall constitute but one Instrument.

     11. Survival of Company’s Obligations to Resigning Trustee and Resigning Escrow Agent.  Notwithstanding the resignation of the Resigning Trustee as Trustee under each of the Indentures, the Company shall remain obligated under each of the Indentures to compensate, reimburse and indemnify the Resigning Trustee in
connection with its services as Trustee as provided in each of the Indentures, and nothing contained in this Instrument shall in any way abrogate the obligations of the Company to the Resigning Trustee under each of the Indentures or any lien
created in favor of the Resigning Trustee thereunder.  The Company also acknowledges and reaffirms its obligation to the Successor Trustee set forth in Section 5.8 of each of the Indentures. Notwithstanding the resignation of the Resigning Escrow
Agent as Escrow Agent under the Pledge Agreement, the Company shall remain obligated under the Pledge Agreement to compensate, reimburse and indemnify the Resigning Escrow Agent in connection with its services as Escrow Agent as provided in the
Pledge Agreement, and nothing contained in this Instrument shall in any way abrogate the obligations of the Company to the Resigning Escrow Agent under the Pledge Agreement or any lien created in favor of the Resigning Escrow Agent thereunder. The
Company also acknowledges and reaffirms its obligation to the Successor Escrow Agent set forth in Sections 9 and 10 of the Pledge Agreement.

     12. Notices. All notices, whether faxed or mailed, will be deemed received when sent
pursuant to the following instructions:

TO THE SUCCESSOR TRUSTEE/SUCCESSOR ESCROW AGENT:

	 	
US Bank National Association

60 Livingston Avenue

EP-MN-WS3C

St. Paul, MN 55107-2292

Attn: Rick Prokosch 

Phone: 651-495-3918

Fax: 651-495-8097

18

TO THE RESIGNING TRUSTEE/RESIGNING ESCROW AGENT:

	 	
Wells Fargo Bank, N.A.

Corporate Trust Services

625 Marquette Avenue; N9311-110

Minneapolis, MN 55479

Attn: Tim Mowdy

Phone: 612-316-1445

Fax: 612-667-9825

	
TO THE COMPANY:

	 	
CV Therapeutics, Inc.

Attn: General Counsel

3172 Porter Drive

Palo Alto, CA 94304

Fax: 650-858-0388

With a copy (which shall not constitute notice) to:

	 	
Latham & Watkins LLP

140 Scott Drive

Menlo Park, CA 94025

Fax: 650-463-2600

Attn: Alan C. Mendelson, Esq.

     13. Effectiveness.  This Instrument and the resignation, appointment and acceptance
effected hereby shall be effective as of the close of business on the Effective Date; provided, that the resignation of the Resigning Trustee as Paying Agent and the appointment of the
Successor Trustee as Paying Agent under each of the Indentures shall be effective 10 days after the date first above written.

	
[Remainder of page intentionally left blank]

19

     IN WITNESS WHEREOF, the parties hereto have executed this Instrument as of the date set forth above.

	
CV Therapeutics, Inc., as the Company

By__________________

Its_____________

US Bank National Association, as the Successor Trustee and Successor Escrow Agent

	
By__________________

Its_____________

Wells Fargo Bank, National Association, as the Resigning Trustee and Resigning Escrow Agent

	
By__________________

Its____________

20

	
EXHIBIT A

Notice to Holders of CV Therapeutics, Inc. [insert title of securities]:

We hereby notify you of the resignation of Wells Fargo Bank, National Association, as Trustee under the Indenture, [insert date of Indenture] pursuant to which your Notes were issued and are outstanding.

CV Therapeutics, Inc. has appointed US Bank National Association, whose Corporate Trust Office is located at 60 Livingston Avenue, EP-MN-WS3C, St. Paul, MN 55107-2292, as successor Trustee under the Indenture, which appointment
has been accepted and become effective.

	
EXHIBIT B

     Documents to be delivered by Resigning Trustee to Successor Trustee as to each of the Indentures (except where noted):

     12. Copy of the most recent of each of the SEC reports delivered by the Company pursuant to each of the Indentures.

	
13.      		
Copy of Indentures.	
	 
	
14.      		
File of Closing Documents.	
	 
	
15.      		
U.S. Treasury Strips held under the Pledge Agreement and identified on	
	 

	
Schedule 1 annexed hereto.

     16. Copy of the most recent Compliance Certificate delivered pursuant to each of the Indentures.

     17. Certified lists of Noteholders as of the Effective Date, certificate detail and all “stop transfers” and the reason for such “stop transfers” (or, alternatively, if there are a
substantial number of registered Noteholders, the computer tape reflecting the identity of such Noteholders).

     18. Copies of any official notices sent by the Trustee to all the Noteholders of the Notes pursuant to the terms of the Indentures during the past twelve months, if any.

	
19.      		
Notes debt service records.	
	 
	
20.      		
Trust account statements for one-year period proceeding the date of this	
	 

	
Instrument.

	
21.      		
All unissued Note inventory, if any or DTC FAST held global certificates.	
	 
	
22.      		
[reserved]	
	 

22

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