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From the Fall 2004 Issue

Learning Center

Medications Used to Treat Heart Conditions

If you have a heart condition, you might feel as if you carry a mini-drug store with you. At LifeBeat Online, we know that many of you want to understand more about some of the typical medications prescribed for heart problems. For each major type of heart medication, we tell you:

• Generic and brand names of common medications
• What the medications are used for
• How they work

Some heart drugs work well together to help a condition. Other drugs should never be taken together. Always tell your doctor or nurse:

• All of the medications you take, even the ones that don't require a prescription
• All vitamin, mineral, or herbal supplements you take
• Any beverages you drink—since some drinks like herbal teas or grapefruit juice can affect some heart drugs
• Any physical problems or conditions you have
• The type of diet you follow

This information will help your doctor prescribe the best medications for your heart condition.

ACE Inhibitors

ACE = angiotensin-converting enzyme. Angiotensin II is a natural chemical made by your body. ACE inhibitors are drugs that affect your body's ability to produce angiotensin II.

Some Generic (and Brand) Names

• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• lisinopril (Prinivil, Zestril)

What They're Used For

• High blood pressure
• Heart failure
• Reducing the risk of stroke
• Reducing the risk of a heart attack
• Reducing the damage from a heart attack that has just occurred
• Also used for treating kidney damage (for example, from diabetes)

How They Work

Angiotensin II, which is made naturally by your body, increases the workload of both your heart and your arteries. Thus it narrows and tightens your arteries and increases your blood pressure. In some people angiotensin II also contributes to heart failure, stroke, and heart attack.

ACE inhibitors decrease the production of angiotensin I, the forerunner of angiotensin II, which results in:

• Relaxing the arteries
• Lowering the blood pressure
• Allowing the heart to work with less effort

Beta Blockers

Some Generic (and Brand) Names

• acebutolol (Sectral)
• atenolol (Tenormin)
• metoprolol (Lopressor)
• propranolol (Inderal)

What They're Used For

• High blood pressure
• Chest pain related to the heart (angina)
• Some irregular heart rhythms
• Heart failure
• Also used for migraines, glaucoma, anxiety, overactive thyroid

How They Work

These medications block the effects of a hormone called norepinephrine. This hormone is related to adrenaline, which makes your heart beat faster and with greater force.

Beta blockers slow your heart rate and keep your blood vessels from narrowing. These two actions can result in:

• Lowered blood pressure
• Less chest pain related to the heart (angina)

Vasodilators

Some Generic (and Brand) Names

• hydralazine (Apresazide)
• isosorbide dinitrate (Isordil)

What They're Used For

• High blood pressure
• Heart failure
• Chest pain that comes from the heart

How They Work

Vasodilators help relax and dilate the blood vessels, so blood moves through them more easily, which in turn:

• Lowers blood pressure
• Allows the heart to work with less effort
• Decreases the amount of chest pain that comes from the heart

Vasodilators are often prescribed for people who cannot take ACE inhibitors.

Anticoagulants (Blood Thinners)

Some Generic (and Brand) Names

• warfarin (Coumadin)

What They're Used For

• Reducing the risk of stroke
• Heart valve disease
• Irregular heart rhythms, especially atrial fibrillation (fast rhythms in the heart's upper chambers)

How They Work

Although these drugs are called blood thinners, they don't actually thin the blood. Rather, they help prevent clotting of the blood.

With some conditions, such as hardening of the arteries (atherosclerosis), a blockage in the arteries can lead to a blood clot.

• If the clot is in the coronary arteries (the blood vessels that provide blood to the heart muscle), it can lead to a heart attack.
• If the clot travels to the brain, it can cause a stroke.

Anticoagulants help prevent blood clots from forming.

Diuretics (Water Pills)

Some Generic (and Brand) Names

• furosemide (Lasix)
• hydrochlorothiazide (Esidrix)
• spironolactone (Aldactone)

What They're Used For

• High blood pressure
• Heart failure—and the edema (excess fluids that swell the legs and feet) caused by heart failure
• Reducing the risk of stroke
• Reducing the risk of heart attack
• Also used for glaucoma, diabetes, liver disease, and kidney failure

How They Work

Diuretics remove water from the body by causing the kidneys to release more sodium (salt) into urine. Sodium draws water out of the blood. By reducing the volume of blood flowing in your arteries, you lower the pressure on your artery walls. Diuretics are inexpensive and effective for many people.

Inotropes

Some Generic (and Brand) Names

• digoxin (Lanoxin)

What They're Used For

• Heart failure
• Irregular heart rhythms, especially atrial fibrillation (fast rhythms in the heart's upper chambers)

How They Work

The term "inotrope" refers to the strength of muscle contractions. The word is usually used to describe the strength and force of the heartbeat.

Inotropic drugs can:

• Make the heart beat more strongly
• Help slow and control the heart rate

Antiarrhythmics

Anti = counter or against; arrhythmia = abnormal heartbeat or heart rhythm

Some Generic (and Brand) Names

• amiodarone (Cordarone)
• flecainide (Tambocor)
• procainamide (Procanbid)
• sotalol (Betapace)
• verapamil (Calan)

Note that beta blockers and ACE inhibitors (both listed above) are also used to treat abnormal heart rhythms.

What They're Used For

• Preventing abnormal heart rhythms
• Preventing the heart from beating dangerously fast
• Restoring normal heart rhythms

How They Work

All of these medications help slow the heart rate by preventing too much of certain chemicals from being absorbed in the cells of your heart.

Amiodarone and sotalol:

• Block some potassium from entering heart cells
• Prevent abnormal rhythms in the ventricles (the heart's lower chambers)

Flecainide and procainamide:

• Block some sodium from entering heart cells
• Prevent abnormal rhythms in the atria (the heart's upper chambers)

Verapamil:

• Blocks some calcium from entering heart cells
• Makes your heart beat less forcefully and less fast
• Prevents abnormal rhythms in the atria
• Lowers your blood pressure

Some of these medications block minerals like calcium or potassium, but that doesn't mean you should try to limit these minerals in your diet. Eating a healthy diet is best for your heart. Check with your doctor to find out if you need to alter your diet.

Other Medications

Other medications can also be used to treat heart disease or lower your cholesterol, including:

• Aspirin
• Lipid-lowering medications (which lower cholesterol)
• Calcium
• Niacin

Tips for Taking Heart Drugs

Here's something you probably already know: it's natural to have blood tests regularly if you take heart drugs. The blood tests help your doctor determine the correct dosage for you.

Never stop taking your medication because you:

• Don't believe you need it anymore
• Don't think it's working properly
• Feel fine without it

In some cases your heart has to adjust to the new drugs for several months before you start to notice any improvement. It also may take time for your doctor to determine the correct dosage.

Make sure you tell your doctor—or any new doctor who might be prescribing drugs for you—about all medications and supplements you take. That way your doctor can help ensure that you get the most benefit from your medications and avoid any harmful drug interactions.

Be sure to talk to your doctor or nurse if you have:

• Questions about the effects of your medications
• Unpleasant side effects
• Trouble remembering to take your pills
• Trouble paying for your medications
• Other factors that prevent you from taking your medications as needed
• Questions about taking any of your medications:
• With other medications or supplements
• On an empty stomach or with meals

Work with your doctor to make sure that you get the best medications for your condition. And don't hesitate to ask your pharmacist if you have questions about how and when to take your medications.

Note: Individual symptoms, situations, and circumstances may vary. Please consult your physician or qualified health provider regarding your condition and appropriate medical treatment. The information provided is not intended to be used for medical diagnosis or treatment or as a substitute for professional medical advice.

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