What Is Heart Disease?
The heart is the body’s main pump for the
movement of blood. It distributes vital blood, oxygen, and nutrients throughout
your body. Coronary heart disease occurs when the blood vessels of the heart
are damaged or diseased. Coronary heart disease can have many serious
consequences. It can lead to a heart attack (myocardial infarction), congestive
heart failure, or arrhythmias, all of which can result in death.
In addition to recommending that a person make
important lifestyle changes, a doctor may prescribe medications. These
medications have several different goals depending upon how heart disease
specifically affects a patient’s heart. Many of the drugs prescribed for people
with heart disease have been definitively proven to extend people’s lives. So,
while some medications may simply help control a symptom or decrease
discomfort, other ones will lower the likelihood that a person with coronary
artery disease (CAD) will die from their disease. It’s very important that
people with CAD take all of their medication exactly as their doctors have
prescribed it for them.
Although coronary artery disease always affects
the patient’s heart, not all CAD is the same and therefore it’s not all treated
in the same way. For example, some patients have trouble with excessive blood
clotting while others need to lower their blood pressure. Patients may need to
utilize multiple medications to manage their heart disease. Each medication
should be taken according to a doctor’s recommendations.
Angiotensin-Converting Enzyme (ACE) Inhibitors
Angiotensin is a hormone that
causes the blood vessels to constrict or get smaller. This raises a person’s
blood pressure. By reducing angiotensin levels, blood vessels enlarge. Blood
flows easier through the enlarged blood vessels, and blood pressure is reduced.
A doctor would prescribe an ACE inhibitor for people with high blood pressure
or heart failure in which the heart does not pump enough blood to meet the
body’s demands. These medications are also vital post-heart attack. This is
because they can help prevent a future event and they also help the heart
muscle recover from the lack of oxygen during the heart attack. Examples of
these medications include benazepril (Lotensin), ramipril (Altacte), and
II Receptor Blockers/Inhibitors (ARBs)
Unlike ACE inhibitors, ARBs
completely block the effects of angiotensin II on the heart. This effect lowers
blood pressure. Doctors prescribe this medication to congestive heart failure
patients and patients with high blood pressure. ARBs and ACE inhibitors have
similar functions and purposes. Studies have shown ACE
inhibitors may slow kidney disease progression in patients with type 1 diabetes
and kidney disease. ARBs may slow kidney disease progression in patents with
type 2 diabetes and kidney disease. Examples of ARBs include losartan (Cozaar)
and valsartan (Diovan). Like ACE inhibitors, ARBs have proven highly beneficial
in enhancing a patient’s recovery after heart attack.
In coronary artery disease, one
of the primary problems is plaque. It can sometimes result in blood clots. If a
clot can becomes lodged in a heart vessel, it can partially or completely
prevent blood from flowing anywhere past the clot. Any heart muscle that relied
on that vessel for oxygen and nutrients will die if blood flow is not restored
very quickly. If a blood clot travels to the lungs, a potentially fatal
pulmonary embolism can result. If a clot lodges in the brain, a stroke could
occur. While anticoagulants don’t break up existing blood clots, they can
prevent blood clots from forming. Examples of anticoagulants include
enoxaparin. (Lovenox), heparin, and warfarin (Coumadin). Anticoagulants are
used to prevent heart attacks and strokes.
Antiplatelet medications are
prescribed after a cardiac event like a heart attack. Doctors also prescribe
them for people with known plaque buildup in their arteries to prevent heart
attacks. People who experience abnormal heart rhythms, such as atrial fibrillation
may also take antiplatelets because they are at increased risk for blood clots.
Examples of antiplatelets include aspirin, clopidogrel (Plavix), and prasurgel
Beta blockers are a broad
category of medications to treat coronary heart disease. While they may have
some shared purposes, they can work in different ways to prevent arrhythmias.
The main purpose of beta blockers is to target the heart’s beta receptors. Beta
blockers can control a heart rate to keep it from beating too fast. They have
protective effects in preventing heart attack and also preventing a second
heart attack in patients who have had heart attacks.
Doctors prescribe beta blockers
to treat hypertension, heart failure, chest pain, and arrhythmias. Examples of
beta blockers include metoprolol (Lopressor), labetalol (Trandate), and
Calcium channel blockers can work
on different aspects of the body to serve specific purposes based on a person’s
unique health condition or conditions. Calcium has several effects on the body.
One of them is to trigger heart contractions. By slowing calcium’s rate in
triggering these contractions, blood vessels can relax. Blood pressure then
lowers. Doctors prescribe calcium channel blockers in patients with
hypertension, chest pain and heart arrhythmias. Examples include amlodipine
(Norvasc), diltiazem (Cardizem), and nifedipine (Procardia).
Cholesterol buildup in the blood vessels can cause plaque to
build up, narrowing blood vessels. This plaque can break off and block the blood
vessel, particularly if a blood clot forms around the plaque rupture. Examples
of cholesterol-lowering medications include the following. Some of these drugs
have also been proven to decrease the risk of death from CAD:
atorvastatin (Lipitor), pravastatin sodium (Pravachol) and simvastatin (Zocor)
- bile acid
resins: cholestyramine (Questran)
absorption inhibitors: ezetimibe (Zetia)
acid derivatives: fenofibrate (Tricor)
acid: niacin (Niacor, Nicolar)
Digitalis medications work to
increase how hard the heart contracts. While these medications are typically
prescribed to treat other heart disease types, such as cardiomyopathy, a person
with coronary heart disease may take these medications. By pumping harder, the
heart can get more blood out in a single beat. Digitalis medications treat
patients with heart failure who may not experience benefits from ACE inhibitors
and diuretics. These medicines also treat irregular heartbeats, including
atrial fibrillation. A medication example is digoxin (Lanoxin).
Nitrates widen blood vessels so
blood can pass more easily. Doctors prescribe them to treat chest pain (angina)
and reduce heart failure symptoms. Examples of nitrates include nesiritide
(Natrecor) and hydralyzine (Apresoline). Nitrates can come as an intravenous (IV)
infusion, a cream formulation, a fast acting tablet that goes under the tongue,
or a traditional pill form.