Great improvements have been made in treating heart conditions, largely due to the research and development of new medicines or drugs. (The term ‘drug’ simply means a medicine.)
www.highbloodpressuresymptoms.co.uk describes some of the different drugs often prescribed for people with a heart condition – for example angina, heart attack, heart failure, heart rhythm disorders or valvular heart disease. It also covers drugs used to control high blood pressure or to lower cholesterol levels, and drugs used to prevent blood clotting. www.highbloodpressuresymptoms.co.uk explains why you may have been given each drug, and how it works. It also describes the most common possible side effects.
www.highbloodpressuresymptoms.co.uk does not replace the advice that your doctors, pharmacists or nurses may give you, but it should help you to understand what they tell you.
Why are there so many different drugs ?
Many different drugs are used to treat the different types of heart disease, but they all belong to a few main types or categories.
A single drug may have several different names. Each drug has one official name (called the ‘generic name’) but it may also be prescribed under one or more trade names (or ‘proprietary names’). Occasionally two drugs are combined in one tablet and have a single trade name.
The drugs within each category are similar, but they may have minor variations. For example, drugs for lowering blood pressure act in different ways. Some act on the artery walls, and some act on the kidneys, and some act on the part of the brain that helps to control blood pressure. If a person can’t take one of these drugs for one reason or another, they may be able to take another type. So, doctors have a wide variety of drugs to choose from and can choose those that best meet the needs of each patient.
Sometimes the same drug can be used to treat a number of different heart conditions.
What do heart drugs do ?
Most drugs used to treat heart conditions change how the heart or the circulation works, rather like a mechanic tuning an engine which is not working as well as it should
How are heart drugs taken ?
Drugs can be taken in a number of different ways.
• Orally – Most drugs for the heart are taken orally (by mouth) as tablets, capsules or powders which you either swallow or take dissolved in water.
• Sublingually – When you place a tablet under the tongue and let it dissolve.
• Aerosol spray – When you spray the drug directly under your tongue.
• Self-adhesive patch – You place a patch containing the drug on your skin and the drug is absorbed over a period of time.
• Intravenously – When a drug is injected directly into a vein (a ‘bolus’ injection), or in diluted form through an intravenous drip.
• Intramuscularly – When a drug is given by an injection into a muscle such as the buttock or thigh.
• Subcutaneously – When a drug is given by an injection just under the skin. (Subcutaneous means ‘under the skin’.)
How often do you need to take the drugs ?
Some drugs need to be taken only when a symptom, such as angina, develops. Others, such as those for treating high blood pressure or preventing angina, need to be taken regularly, as your doctor has prescribed. (In most cases, you need to take the tablets once or twice a day, but sometimes more frequently.) It could be dangerous to stop taking your medicines without medical advice. If you get any unwanted side effects, you should contact your doctor, but don’t stop taking the medicines that have been prescribed for you.
Side effects
Most drugs used to treat heart disease are very safe. Dangerous side effects are rare. However, minor side effects happen quite often and you need to be awareof the more common ones. Some side effects result from the action of the drug. For example, if you are given too large a dose of a drug for treating high blood pressure, your blood pressure will fall too low and you may feel faint. Other side effects are not related to the main action of the drug – for example, skin rashes. Doctors and pharmacists should warn you of the common side effects of the drugs prescribed. For more information about possible side effects of the drugs that you are taking, look at the information sheet that comes with each new pack of tablets. Remember that, by law, these sheets have to list all the possible side effects, but most of the side effects are uncommon.
What to do if you get side effects
If you develop any new symptoms or problems after starting on a drug, it is important to tell your doctor about them. But don’t stop taking your prescribed medicines without medical advice, as this could be dangerous. If you are worried about minor side effects, you can ask your pharmacist for advice.
Choosing a drug and the dose
Several different drugs may be available for treating your heart condition. Your doctor will choose the ones which are most likely to be effective for your condition and which are suitable and safe for you. However, people vary greatly in how they respond to individual drugs, so it is difficult to know exactly which will suit a particular patient.
The same applies to the dosage of drugs. Often the most suitable dosage has to be found by trying it out and getting feedback from you. Some people will need to have their blood pressure recorded regularly, or have blood tests, to establish the correct dose.
Why are drugs used ?
Drugs may be used to treat:
• angina
• heart attack
• high blood pressure
• heart failure
• arrhythmias (disorders of heart rhythm)
• valvular heart disease, and
• a high blood cholesterol level.
Some drugs benefit more than one condition. Some can also be used to help prevent coronary heart disease.
Angina
Angina is an uncomfortable feeling or pain in the chest which can be brought on by physical activity or emotional upset. Angina is caused by a poor supply of oxygen to the heart muscle. This happens when the coronary arteries (the arteries that supply oxygen-containing blood to the heart muscle) become narrowed by a gradual build-up of fatty material (atheroma) within their walls. In time the artery may become so narrow that it cannot deliver enough blood to the heart. This is what causes the pain known as angina.
The main drugs used to prevent or treat angina are
beta-blockers, calcium channel blockers, nitrates, potassium channel activators, and anti-platelet drugs such as aspirin which is sometimes used together with another anti-platelet drug called clopidogrel.
Heart attack
Also called myocardial infarction or coronary thrombosis This is usually due to a blood clot blocking a coronary artery which has been previously narrowed by a gradual build-up of fatty material (atheroma) within its walls. The initial treatment includes some drugs to relieve the pain, and others to deal with the clot including thrombolytics (also called ‘clotbusters’ ) and aspirin. Other drugs are often needed to deal with complications, and to prevent further attacks.
High blood pressure
Also called hypertension If blood pressure is persistently high, it can lead to coronary heart disease, heart failure, stroke and kidney damage. There is a wide range of drugs available to help control high blood pressure, including ACE inhibitors, angiotensin ll antagonists ,beta-blockers , calcium channel blockers, diuretics , alpha-blockers,methyldopa and moxonidine.
A large research study (called the ASCOT Study) recently found that, when people with high blood pressure took a combination of a calcium channel blocker and an ACE inhibitor to reduce their blood pressure, it significantly reduced their risk of having a heart attack or stroke or developing diabetes, compared with taking medicines such as a beta-blocker and a diuretic. The study only looked at the effect of taking particular types of those drugs – amlodipine (a calcium channel blocker) and perindoril (an ACE inhibitor) compared to taking atenolol (a beta-blocker) and bendroflumethiazide (a diuretic). Further research is needed to find out if other types of calcium channel blockers and ACE inhibitors would have a similar effect.
The research also showed that, when people with high blood pressure take a combination of a calcium channel blocker and an ACE inhibitor as well as atorvastatin (a type of cholesterol-lowering medicine which we describe even if their cholesterol level was normal to start with, their risk of having a heart attack or stroke was halved.
Whatever drugs you are taking, you can reduce your risk of having a stroke or heart attack by controlling your blood pressure so that it’s within the recommended limits.It is important to remember that the ASCOT Study looked at using only one type of beta-blocker called atenolol for treating high blood pressure. Beta-blockers are very effective in treating people who have had heart attacks, who have heart failure or who have angina. If you’re already taking beta-blockers, you should not stop taking them suddenly. If you have any questions about your medicines, continue taking them but see your doctor to discuss them.
Heart failure
The term heart failure is used when the heart fails to pump enough blood around the body. There are four stages of heart failure. Each of these stages can be associated with different symptoms, such as breathlessness or tiredness in the early stages, or swelling of the feet, ankles or abdomen (stomach area) in the later stages. The most common causes of heart failure are heart attack and high blood pressure.
Diuretics are often combined with ACE inhibitors and sometimes digoxin to treat heart failure. Sometimes, if a person cannot take ACE inhibitors, angiotensin ll antagonists are used. Some people who cannot take either ACE inhibitors or angiotensin II antagonists may be treated with nitrates and a vasodilator (a drug that makes your arteries wider).
Potassium sparing diuretics can also help people with heart failure. Certain beta-blockers may also be useful in treating mild to moderate heart failure.
Arrhythmias (disorders of the heart rhythm)
A variety of ‘anti-arrhythmic’ drugs are used to treat disturbances of the heart rhythm.Anticoagulants may also be used.
Valvular heart disease
Diseased or damaged heart valves affect the flow of blood through the heart. This causes a strain on the heart and circulation. The drugs that may be used to treat the symptoms include ACE inhibitors,digoxin and diuretics. If a mechanical replacement valve is inserted, anticoagulants are needed. Anticoagulants are sometimes also prescribed for people who have had a tissue valve replacement. Nitrates or calcium channel blockers are not suitable for people with certain valvular heart conditions. And, some people may not be able to take ACE inhibitors. If you have a valvular heart condition, your doctor will discuss with you the best type of drugs for you.
Preventing coronary heart disease
Drugs may also be used to control some of the risk factors responsible for coronary heart disease, especially if changing your lifestyle will not be enough. These include drugs to reduce a high level of cholesterol in the blood (also called ‘cholesterol-lowering drugs’ or ‘lipid-lowering drugs’ ), to lower raised blood pressure, and to prevent blood clotting.
© 2008 highbloodpressuresymptoms.co.uk
