Heart medicines

If you have any questions about the medication you are on, please ask your GP, cardiologist or pharmacist. The below is just a guide to explain about some of the commoner treatments that can be used.

1. Diuretics

If you experiencing a condition called congestive heart failure, you may find that you have more fluid in your body. This can in turn result in breathlessness and swollen ankles, as fluid builds up in the wrong places (such as your lungs or your legs) as a result of the heart being weak. Diureticshelp relieve these symptoms by making your body get rid of the extra fluid. Because of this, when you take diuretics, you will usually find that you need to urinate more frequently.

The names of some of the common diuretics used are furosemide, bumetanide, spironolactone, eplerenone, bendroflumethiazide, metolazone and amiloride.

2. Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs)

The main actions of angiotensin converting enzyme (ACE) inhibitors are that they relax your blood vessels and reduce how much fluid is reabsorbed by the kidneys. This in turn helps to reduce blood pressure. In addition, as a combined result of these and other actions, they can strengthen a weakened heart and therefore are very important in the treatment of heart failure.

As with every medication, however, ACE inhibitors are associated with some side effects worth mentioning which may affect some people. The most common are low blood pressure (hypotension) and a dry cough. If you feel dizzy or faint after starting ACE inhibitors, it may be that they have lowered your blood pressure too much. You should therefore see your doctor, as your dose may need adjusting.

About 10% of people who take ACE inhibitors can develop a dry cough. Again, you should see your doctor about this, as there are alternatives that can be used which are called the angiotensin receptor blockers (ARBs), which (have similar effects as ACE inhibitors but tend not to produce a cough). The names of some of the common ACE inhibitors used these days are ramipril, captopril, enalapril, lisinopril, fosinopril and perindopril. ARBs include candesartan, irbesartan, losartan and valsartan.

3. Beta-blockers

Beta-blockers reduce the effect of adrenaline on the heart. This results in the heart being slower, and with less force, therefore reducing its workload. You may experience some side effects when you are taking beta-blockers, including dizziness and feeling faint, which may mean that your heart is beating too slowly – if this is the case, then please see your doctor. You should not take beta-blockers if you have asthma or other breathing problems. Examples of beta-blockers are atenolol, bisprolol, metoprolol, carvedilol, propranolol, sotalol and nebivolol.

4. Antiarrhythmics

An arrhythmia simply means that the heart is not beating normally – either too slowly (bradycardia), too fast (tachycardia) or irregularly. Arrhythmias can be controlled using anti-arrhythmic drugs. Because arrhythmias are usually due to problems with the electrical impulses in the heart, anti-arrhythmics work by stabilising these electrical impulses in a variety of different ways. They can be divided into four different classes, according to the effects that they have on the heart; as you can see, some of them have multiple effects:

Class 1: stabilize the cell membranes in the heart (e.g. flecainide, procainamide,  disopyramide and lignocaine,)

Class II: reduce output from the adrenal glands, so that there is less adrenaline –  which ordinarily excites the heart – affecting it (e.g bisoprolol, metoprolol, atenolol, propranolol and sotalol)

Class III: Block potassium channels in the heart (e.g. sotalol and amiodarone)

Class IV: Block calcium channels in the heart e.g. (verapamil and diltiazem)

4. Anticoagulants and antiplatelets

If you have a disturbance of your heart rhythm (arrhythmia) which makes the heart beat irregularly, you may be more prone to forming blood clots within it. And in some people, if the heart is enlarged and weakened (such as those with dilated cardiomyopathy), they may also be prone to developing clots within it (or in some cases, may already have developed these at some point in the past). You could therefore be put on medications to prevent this happening, or to help the body dissolve clots that have already formed.

Anticoagulants make the blood thinnerto prevent clots from forming, and also aid the body in breaking up clots that have already formed by stopping them getting any bigger. Antiplatelets make the blood less ‘sticky’,  again preventing clots forming. Warfarin is the commonest anticoagulant used; aspirin and clopidogrel are two commonly used antiplatelets. Most people are usually either on an anticoagulant or an antiplaletet, but not both together as this can make the blood too thin and therefore make you prone to bleeding (although there are rare cases where both are used together).

If you are taking an anticoagulant (warfarin), you will need to have regular blood tests to ensure that your blood has not become ‘too thin’ and that you are on the correct dose. This is called an international normalised ratio (INR) test. Your INR should ideally be between 2.5-3.5, but can vary depending on your individual circumstances. Certain foods, drinks and medication can also interact with warfarin, either increasing its effects and making the blood too thin, or decreasing its effects and preventing it from thinning the blood. You will therefore be advised to avoid changes in your diet once you are established on the correct dose of warfarin. Examples include grapefruit and cranberry juice (increase the effect of warfarin, making the blood too thin) and liver, broccoli and brussels sprouts (contain vitamin k which reduces the effects of warfarin, making the blood less thin). Please ask your doctor about more information on foods and medications to avoid.

If you are taking anticoagulants, it is VERY important that you carry a card that says that you do. This information will be extremely helpful for doctors to know if you have an accident. Please click here more information on alerting people to your diagnosis in an emergency.

Remember – If you notice any side effects from your medication talk to your doctor or pharmacist straight away!

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