Typical drug treatments

Typical drug treatments for cardiac issues include:

Beta blockers
Calcium antagonists
Nitrates
ACE inhibitors
Angiotensin receptor blockers
Diuretics
Antiarrhythmic drugs
Blood thinning/anticoagulation

Beta blockers

This includes a group of drugs ending in ‘-ol’, such as atenolol, metoprolol, nebivolol, carvedilol and bisoprolol. This group of drugs acts primarily by reducing the heart rate and the strength of heart contraction. The major use of these drugs is for treating angina. They are sometimes used in arrhythmias such as atrial fibrillation, atrial flutter and other SVTs, and to treat heart failure.

Calcium antagonists

Includes drugs such as amlodipine, nifedipine, felodipine, lercandipine, diltiazem and verapamil. These drugs act to dilate blood vessels, and have applications in treating angina and hypertension.

Nitrates

Includes drugs such as GTN spray and isosorbide mononitrate. This class of drugs dilates blood vessels directly and can be used to treat angina by dilating coronary arteries.

ACE inhibitors

These are drugs ending in ‘-pril’, such as lisinopril, perindopril, ramipril, enalapril and trandolopril. ‘ACE’ stands for Angiotensin Converting Enzyme. By inhibiting the enzyme, blood vessels dilate, and this effect can be used to treat hypertension.

Angiotensin receptor blockers

These are ‘cousins’ to the ACE inhibitors, acting on blood vessels in a slightly different way to reduce pressure and resistance. They’re used especially when ACE inhibitors are not tolerated. As with ACE inhibitors, they’re used in hypertension and heart failure, and have even fewer side effects.

Diuretics

These are commonly referred to as ‘water pills’, as they assist in removing extra fluid from the circulation. So, in heart failure where excess fluid accumulates in the legs and the lungs (causing breathlessness), diuretics will offload the excess. They can be used in resistant hypertension and as an additive in resistant heart failure.

Antiarrhythmic drugs

These include beta blockers and calcium antagonists. The most commonly used antiarrhythmics include:

> Digoxin, used to treat heart rate increases in atrial fibrillation
> Flecainide and Propafenone, primarily used for supraventricular tachycardia, as well as in atrial fibrillation and flutter
> Sotalol primarily used to treat atrial fibrillation
> Amiodarone, a very important drug used to treat both atrial and ventricular arrhythmias

Blood thinning/anticoagulation

These drugs are used to reduce the tendency to reduce clots, either in the arterial system such as the coronary arteries, or to prevent clots building up in the veins or heart chambers.

> Aspirin reduces the stickiness of platelets in the blood to prevent clots building up within arteries. Treatment is usually lifelong after a heart attack or stent.
> Clopidogrel is another type of platelet drug that reduces clot build up. In patients with heart attacks, clopidogrel provides additional protection when added to aspirin.
> Warfarin works by acting on the coagulation profile rather than platelets, and is used to treat larger clots.