Drugs Used in Disorders of the Heart
Robin Brain
December 02, 2008
Drugs
Antiplatelet drugs, antioxidants (vitamin E, bioflavonoides) and lipid reducing drugs have a definite role in overall management of CAD. These will be discussed later. Reduction of raised lipid levels by diet, regular exercise and stress-relief are non-drug modalities.
Drugs Used in Unstable Angina
Since many cases with continuous chest pain in this condition may progress to real heart attack aggressive treatment is required. Aspirin 150-325 mg with clopidogrel 75mg, intravenous nitroglycerin an heparin or low molecular weight heparin is also given. Atenolol or other betablocker is also used. If drugs are are not effective, an angiography and angioplasty is undertaken to open the blocked vessels, circulation is reestablished with a bypass.
Treatment of Myocardial Infarction
In myocardial infarction there is pain in the chest which may spread towards the stomach or left arm, similar to that caused in angina. It is more severe in intensity and lasts longer than anginal pain. It maybe associated with a pain in the stomach region and is often confused with pain due to acute indigestion or gas formation. Myocardial infarction is usually associated with a feeling of weakness, sweating, nausea, vomiting, giddiness and impending doom.
Myocardial infarction is caused by occlusion or obstruction of a coronary artery by a thrombus (blood clot adhering to the wall of the artery). The part of the muscles to be perfused by the obstructed artery becomes ischaemic or deficient in blood supply and the cells of the muscles die. They are finally replaced by fibrous tissues in vessels. Myocardial infarction is a medical emergency and the patient must seek medical aid as soon as possible. In most cases it has been observed that the delay is not only because of the time taken in transporting the patient to the hospital or the arrival of the physician, but also due to the delayed decision to call for medical help after the realization of the pain. Early treatment with thrombolytics have changed the outlook of this disease. Remember the golden hours; the first 4-6 hours of the onset of chest pain when cell death could be prevented by thrombolytics. So rush!! Don't wait.
The treatment of myocardial infarction consists of: I) immediate steps which should be taken; and 2) continued use of drugs to avoid further complications.
Immediate Treatment and Drugs
Relief from Pain: For relief of pain the most effective drug is morphine. It may cause some amount of nausea initially but the pain is relieved quickly and soon gives a feeling of well-being. It may produce a slight fall in blood pressure which is helpful in decreasing the workload on the heart. It is advisable to give morphine in as small a dose as possible. In some cases it can produce a severe fall in blood pressure. A dose of 5 mg given intravenously or subcutaneously is usually sufficient in providing relief from pain. Buprenorphine can be given in place of morphine.
Oxygen lnhalation: Oxygen inhalation through nasal prongs or face mask helps to increase its concentration in the blood which may diffuse into the affected area of the heart through better perfused adjacent areas. It is often administered for the first 4 or 5 days.
Rest: Rest reduces the work of the heart and restricts the area of the muscle suffering from decreased oxygen supply. It has been found that about 6 to 8 weeks are required for the healing of the affected area. While earlier complete bed rest for about 6 weeks was recommended, most cardistogists these days do not consider it necessary, but believe that early mobilization helps to improve muscle tone and the general body condition, and the complications are minimized. According to current practice, a hospitalised patient with an uncomplicated condition can sit in a chair on second day and walk upto toilet on third day. He can return home in 5 to 7 days. The patient should not stand up suddenly as there may be a fall in blood pressure. After 4 to 6 weeks he is encouraged to gradually return to work. He should have adequate sleep at night and lie down for an hour both in the afternoon and evening. After 8 weeks the activity should be regulated according to exercise tolerance. Driving is permitted at this time.
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Antiplatelet drugs, antioxidants (vitamin E, bioflavonoides) and lipid reducing drugs have a definite role in overall management of CAD. These will be discussed later. Reduction of raised lipid levels by diet, regular exercise and stress-relief are non-drug modalities.
Drugs Used in Unstable Angina
Since many cases with continuous chest pain in this condition may progress to real heart attack aggressive treatment is required. Aspirin 150-325 mg with clopidogrel 75mg, intravenous nitroglycerin an heparin or low molecular weight heparin is also given. Atenolol or other betablocker is also used. If drugs are are not effective, an angiography and angioplasty is undertaken to open the blocked vessels, circulation is reestablished with a bypass.
Treatment of Myocardial Infarction
In myocardial infarction there is pain in the chest which may spread towards the stomach or left arm, similar to that caused in angina. It is more severe in intensity and lasts longer than anginal pain. It maybe associated with a pain in the stomach region and is often confused with pain due to acute indigestion or gas formation. Myocardial infarction is usually associated with a feeling of weakness, sweating, nausea, vomiting, giddiness and impending doom.
Myocardial infarction is caused by occlusion or obstruction of a coronary artery by a thrombus (blood clot adhering to the wall of the artery). The part of the muscles to be perfused by the obstructed artery becomes ischaemic or deficient in blood supply and the cells of the muscles die. They are finally replaced by fibrous tissues in vessels. Myocardial infarction is a medical emergency and the patient must seek medical aid as soon as possible. In most cases it has been observed that the delay is not only because of the time taken in transporting the patient to the hospital or the arrival of the physician, but also due to the delayed decision to call for medical help after the realization of the pain. Early treatment with thrombolytics have changed the outlook of this disease. Remember the golden hours; the first 4-6 hours of the onset of chest pain when cell death could be prevented by thrombolytics. So rush!! Don't wait.
The treatment of myocardial infarction consists of: I) immediate steps which should be taken; and 2) continued use of drugs to avoid further complications.
Immediate Treatment and Drugs
Relief from Pain: For relief of pain the most effective drug is morphine. It may cause some amount of nausea initially but the pain is relieved quickly and soon gives a feeling of well-being. It may produce a slight fall in blood pressure which is helpful in decreasing the workload on the heart. It is advisable to give morphine in as small a dose as possible. In some cases it can produce a severe fall in blood pressure. A dose of 5 mg given intravenously or subcutaneously is usually sufficient in providing relief from pain. Buprenorphine can be given in place of morphine.
Oxygen lnhalation: Oxygen inhalation through nasal prongs or face mask helps to increase its concentration in the blood which may diffuse into the affected area of the heart through better perfused adjacent areas. It is often administered for the first 4 or 5 days.
Rest: Rest reduces the work of the heart and restricts the area of the muscle suffering from decreased oxygen supply. It has been found that about 6 to 8 weeks are required for the healing of the affected area. While earlier complete bed rest for about 6 weeks was recommended, most cardistogists these days do not consider it necessary, but believe that early mobilization helps to improve muscle tone and the general body condition, and the complications are minimized. According to current practice, a hospitalised patient with an uncomplicated condition can sit in a chair on second day and walk upto toilet on third day. He can return home in 5 to 7 days. The patient should not stand up suddenly as there may be a fall in blood pressure. After 4 to 6 weeks he is encouraged to gradually return to work. He should have adequate sleep at night and lie down for an hour both in the afternoon and evening. After 8 weeks the activity should be regulated according to exercise tolerance. Driving is permitted at this time.
Get more information on Generic Names for Prescription Drugs and Generic Drug Industry.