Drugs used for treatment of heart diseases and heart disease symptoms

Cardiac Glycosides (Digitoxin, Digoxin): Cardiac glycosides are also known as digitalis drugs. They are found in the leaves of certain plants and have been refined or synthesized to be used in the treatment of certain heart disorders. If you suffer from some types of heart rate or rhythm disorders (e.g  atrial fibrillation) or from heart failure , or if your heart muscle has been weakened by a heart attack, your doctor may prescribe cardiac glycosides.

Cardiac glycosides slow down the passage of electrical impulses through the heart muscle, thus slowing down a fast, erratic heart beat. They also enhance muscle contraction, so the heart beats more powerfully and efficiently. Your blood will be monitored regularly during treatment with cardiac glycosides. If your blood level of potassium is low you will be given a potassium supplement to reduce any risk of altered rhythm caused by the interaction of low potassium and the drug.

If you are taking cardiac glycosides to relieve the symptoms of heart failure, you should notice a fairly rapid improvement of symptoms such as breathlessness, ankle swelling, and fatigue. Occasionally, people taking cardiac glycosides experience increased tiredness, confusion, and digestive disturbances such as loss of appetite, stomach pain, and nausea or vomiting. This is usually because too high a dose of the drug is being taken. Report any problems to your doctor so that he or she can check the level of the drug in your blood and adjust it if necessary.

You will take your cardiac glycosides in tablet, capsule, or liquid form, depending on the type prescribed. In an emergency you may be given an injection of the drug to produce a rapid effect. Occasionally, cardiac glycosides are prescribed as a short term treatment. However, you will probably need to take them indefinitely because they do not cure the underlying problem.

Nitrates (e.g. Isosorbide dinitrate,  Nitroglycerin): If you suffer from angina , your doctor may prescribe a nitrate drug. Nitroglycerin, is still considered a valuable drug for the treatment of angina.

Nitrate drugs relax the muscles surrounding the blood vessels so that they dilate (widen). This improves the flow of blood through the arteries around the heart and, by widening the blood vessels, promptly relieves an angina attack. If taken before an angina producing activity (exercise or exposure to cold weather), nitroglycerin may prevent angina.

Nitrate drugs can reduce both the pain and the frequency of your angina attacks, so you should notice an improvement soon after beginning treatment. Occasionally, people taking nitrate drugs experience side effects such as flushing, headache, dizziness, fainting, or edema; the dizziness and fainting are caused by a drop in blood pressure.

Your doctor will prescribe nitrates with caution if you have glaucoma, thyroid problems, or certain blood disorders, or if you are pregnant. Also you cannot take Viagra with nitrates as this might produce fatal hypotension.

Nitrates are taken in different ways, depending on whether they are being used to treat or to prevent angina attacks. Methods of administration include tablets, capsules, injection, spray, ointment, and skin patches. They may be taken as needed, or several times daily as a preventive measure. Your doctor may suggest that you take your first dose while lying down, in case you feel dizzy. A large overdose may cause dizziness, vomiting, severe headache, seizure, or loss of consciousness; it should be treated as a medical emergency.

Calcium Channel Blockers (e.g. Nicardipine, Verapamil, Nifedipine):

Calcium channel blockers are useful for treating many kinds of heart and circulation disorders. They help prevent attacks of angina, and regulate the heartbeat in heart rate and rhythm disorders. They also improve the circulation, which is useful in treating some arterial disorders and hypertension . Because they reduce the work load of the heart, they may be prescribed for heart failure. They are also used after CABG surgery in which a radial artery graft have been used to help keeping it patent.

Calcium channel blockers impede the flow of calcium into the muscles surrounding blood vessels so that the blood vessels are dilated (widened). As a result, the effort needed for the heart to pump blood around the body is also reduced. Your doctor will prescribe these drugs with caution if you have unstable blood pressure, impaired kidney or liver function, or if you are pregnant or breast feeding.

If you suffer from angina, calcium channel blockers will reduce the frequency of your attacks, but only some types work rapidly enough to relieve the pain of an attack itself. Your circulation will improve, which is why these drugs sometimes help people who suffer from Raynaud’s disease.

Calcium channel blockers may cause headache, nausea, edema, constipation, flushing, or lethargy. Occasionally, they cause dizziness; if you are affected in this way, do not drive or drink alcohol.

You will take your calcium channel blockers in tablet or capsule form. The drug will be taken between one and four times daily, depending on how long the dose remains active.

While calcium channel blockers improve certain conditions dramatically (such as severe arrhythmias, angina, hypertension, and, in some instances, migraine), they generally cannot cure the underlying problem, so they may need to be taken indefinitely.

Diuretics (water pills):

1. Thiazide diuretics: e.g. Hydrochlorothiazide
2. Loop diuretics: e.g. Furosemide
3. Potassium-sparing diuretics: e.g. Spironolactone

If you have excess fluid in your body as a result of heart failure, or if you are suffering from hypertension, your doctor may prescribe a diuretic drug. All diuretics reduce the blood volume and therefore lower blood pressure and ease the heart’s work load.

Diuretics interfere with the action of the kidneys to reduce the amount of water reabsorbed into the blood stream. As a result, more fluid is drawn out of the tissues and expelled as urine. There are three common types of diuretic drugs. Each works on a different part of the small tubes (tubules) in the kidneys.

Your doctor will prescribe diuretics with caution if you have gout or diabetes. Thiazide and loop diuretics can cause excessive loss of potassium from the body, which can have toxic effects. If your doctor believes there is a risk of potassium depletion, you may be prescribed a potassium-sparing diuretic. Alternatively, a potassium supplement may be prescribed with a thiazide or loop diuretic.

If you have edema or breathlessness , you should notice an improvement soon after you start taking your diuretic. You will need to urinate more frequently and, with loop diuretics, you may initially feel dizzy. Some diuretics cause leg cramps or temporary impotence, and some may cause nausea.

Diuretics are usually taken in tablet form, although a diuretic may be injected for a more rapid effect.

Diuretics don’t cure your underlying condition, so you may need to take them indefinitely. Never stop taking the diuretics without checking with your doctor.

Blood thinners (antiplatelets, anticoagulants, and thrombolytics):

Antiplatelets (Aspirin, Dipyridamole, clopidogrel {plavix}): When there is an area of atheroma ( fatty deposit) in a blood vessel, platelets (small cells in the blood) tend to form sticky clumps around the atheroma. These clumps may develop into a blood clot. Antiplatelet drugs reduce the stickiness of the platelets, making them less likely to clump together and clot.

Antiplatelet drugs may be prescribed by your doctor after a heart valve replacement operation , or if you suffer from coronary heart disease, or from transient ischemic attacks.  Generally, antiplatelet drugs are not prescribed for children. Your doctor will prescribe them with caution if you suffer from a stomach ulcer or bleeding disorder, if you have impaired kidney or liver function, or if you are pregnant or breast feeding. The use of antiplatelet drugs can reduce the severity and frequency of angina and help reduce the frequency of heart attacks  and transient ischemic attacks. Some people taking antiplatelet medication experience nausea, vomiting, or indigestion.

Antiplatelet drugs are taken as tablets or capsules. In some cases, aspirin is administered as a rectal suppository. The frequency of the dose depends on your condition. Since antiplatelet drugs do not cure the underlying problem, they often need to be taken indefinitely.

Some antiplatelet drugs are more potent than others, but any overdose should be treated as an emergency; get medical attention immediately.

Anticoagulants (Warfarin, Heparin): If your blood has a tendency to form clots easily, or if you have just undergone surgery or been involved in an accident, your doctor may prescribe anticoagulant drugs to stabilize any existing clots and to try to prevent others from forming.

Anticoagulants interact with many other kinds of drugs, including aspirin, laxatives, and oral contraceptives. Always check with your doctor before taking any other medication if you are taking anticoagulants.

You may find that you experience extra bruising, or occasional bleeding from the nose, gums, or urinary tract. You may also have digestive disturbances such as nausea.

Generally, you will take the drug orally as capsules or tablets, but occasionally an anticoagulant is injected intravenously in an emergency or before or after surgery. With many anticoagulants (particularly if you are taking warfarin), it is best to avoid alcohol, since it can increase the drugs effect beyond the desirable limit. Anticoagulants are usually prescribed for life, especially in people who have an artificial mechanical heart valve. During your treatment you will be given regular blood tests (INR level) to ensure that the best dose for your condition is being prescribed; the dosage may be altered periodically.

Thrombolytics (Streptokinase, Tissue plasminogen activator): When a blood clot forms in a blood vessel, it is bound together by strands of fibrin and normally cannot be broken down easily or rapidly. Thrombolytic drugs increase the blood level of plasmin, a substance that quickly breaks down the fibrin strands, so these drugs can be used to dissolve clots that have already formed. If you have had a heart attack, your doctor may inject a thrombolytic drug within a few hours of the attack to limit the damage to the heart and, ideally, to reopen a blocked coronary artery. Greatly enhanced survival rates are derived from these drugs only when they are given within 4 hours of the onset of the heart attack.

Thrombolytic drugs act very quickly and may dissolve an existing clot immediately. One side effect is an increased susceptibility to bruising and bleeding from even minor accidents. Streptokinase has been known to cause allergic reactions in some people. These reactions are treated with antihistamines and corticosteroid injections.

Thrombolytic drugs are usually administered in the hospital to clear specific clots; they may be given by intravenous infusion or may be injected directly into the affected blood vessel.

Beta Blockers (e.g. Atenolol, nadolol, metoprolol)

If you suffer from angina, hypertension, a heart rhythm disorder, or hypertrophic cardiomyopathy, your doctor may prescribe beta blockers. Beta blockers decrease your heart’s oxygen requirements, reducing blood pressure and controlling certain kinds of rapid heartbeats. If you have had a heart attack, your doctor may give you a course of beta blockers to help prevent more damage to your heart muscle.

If you suffer from angina or arrhythmia, you should notice an improvement in your condition within days or even hours after beginning treatment with beta blockers. If you are taking beta blockers for hypertension, you may not be aware of the drugs beneficial effects.

Your doctor will prescribe beta blockers with caution if you have respiratory problems such as asthma or bronchitis, if you have poor circulation, or if you are pregnant. If you are diabetic, beta blockers may mask your normal warning symptoms of low blood sugar.

Because the drugs may reduce circulation to the extremities, you may suffer from cold hands and feet. Occasionally, for the same reason, people taking beta blockers may experience lethargy, faintness, or temporary impotence.

You will take your beta blockers in either tablet or capsule form, between one and four times daily. Under some circumstances, beta blockers are administered in the hospital directly by injection.

Your doctor may suggest that you take the drugs indefinitely so that the beneficial effect is maintained. You should not stop taking your beta blockers suddenly; this can cause a severe recurrence of the original problem. Your doctor may ask you to stop the drugs gradually before any scheduled surgery.

ACE inhibitors (e.g. Captopril, Enalapril, Lisinopril):

If you suffer from hypertension, especially if you have had adverse reactions to other antihypertensive drugs, your doctor may prescribe ACE inhibitors. They are occasionally used with diuretics to treat severe heart failure.

ACE stands for angiotensin converting enzyme. ACE inhibitors prevent the action of a particular enzyme that promotes the constriction of blood vessel walls. As a result, the blood vessels dilate (widen), easing the flow of blood and reducing blood pressure.

Your doctor will prescribe ACE inhibitors with caution if you have impaired kidney or liver function, or if you are pregnant or breast-feeding. The possible adverse effects of the drugs may be more noticeable if you are elderly.

ACE inhibitors rapidly control blood pressure, but because hypertension usually doesn’t cause any symptoms you may not experience any noticeable benefits. Because the action of the drugs is so rapid, you should ideally take your first dose when you are lying down, in case you feel dizzy or faint. Similarly, when taking these drugs, it is wise to rise slowly from a sitting or lying position to prevent feelings of dizziness or faintness. A cough may develop in some people who take these drugs. Digestive disturbances, such as loss of taste or appetite, nausea, vomiting, or diarrhea, may also occur.

ACE inhibitors also commonly affect the function of the kidneys, causing excessive fluid loss and general weakness. They sometimes also depress the action of the body’s immune system, increasing susceptibility to infection.

Your doctor will prescribe ACE inhibitors in tablet form; the dose varies between one and three times daily. Because food inhibits the absorption of ACE inhibitors from the intestines, you may be advised to take the drugs before meals. An overdose of ACE inhibitors may cause dizziness and fainting; seek medical advice if you notice any unusual symptoms or if a large overdose has been taken.

ACE inhibitors don’t cure the underlying condition, so you may need to take the drug indefinitely. Don't stop taking the drug without consulting your doctor; the original problem may recur.

Lipid-Lowering Drugs (e.g. Lovastatin, Cholestyramine)

People with hyperlipidemia  (high levels of fats in the blood) are at high risk of atherosclerosis. If you suffer from hyperlipidemia, especially if you are diabetic or have circulatory disorders or a family history of heart attacks, treatment with a low-fat diet alone is unlikely to be effective. To bring down the level of fats in your blood, your doctor may prescribe lipid-lowering drugs.

There are two main types of lipid lowering drugs, those that act on the liver and those that act on the bile salts. Drugs that act on the liver alter the enzyme activity in the liver to block the conversion of fatty acids to lipids. Ultimately, this action reduces the level of lipids in the blood, which can be lifesaving for people who have hyperlipidemia. Drugs that act on the bile salts reduce the reabsorption of bile salts into the blood stream from the intestine. Because bile salts contain large amounts of cholesterol (a type of lipid), the effect of the drugs is to lower the level of lipids in the blood.

Because hyperlipidemia does not cause noticeable symptoms, you probably will not be aware of the beneficial effects of the drug. However, the lipid lowering drug should prevent more buildup of atheroma in your arteries. The drugs may cause digestive disturbance, which should improve as treatment continues. Certain drugs may also increase your susceptibility to gallstones.

Your doctor will prescribe lipid lowering drugs with caution if you have impaired kidney or liver function, if you have jaundice or gall stones, or if you have certain problems with your digestive tract.

Lipid lowering drugs may come as tablets or capsules, or as powders to be mixed with juice or soft food. The frequency of treatment is between one and four times daily.

Lipid-lowering drugs don’t cure the underlying condition that causes hyperlipidemia, so you may have to take the drugs indefinitely.