Medications for Heart Attack
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The information provided here is meant to give you a general idea about each of the medication categories listed below. Listed medications are only examples of pharmaceuticals within each group. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Emergency medical personnel may begin treating you with medications before you reach the hospital. At the hospital, additional drugs will be given and you will likely receive medications to take at home after you are discharged.
Prescription Medications
Opioid Analgesics (Pain Medication)
- Morphine
- Dilaudid
- Fentanyl
- Nitroglycerin
- Tissue plasminogen activator (tPA)
- Streptokinase
- Reteplase
- Tenecteplase
- Lanoteplase
Sodium Channel Blockers (Class I)
- Procainamide (Procan-SR, Pronestyl)
- Quinidine (Cardioquin, Quinidex Extentabs)
- Disopyramide (Norpace)
- Lidocaine
- Flecainide (Tambocor)
- Tocainide (Tonocard)
- Amiodarone (Cordarone)
- Mexiletine (Mexil)
- Propafenone (Rythmol)
- Moricizine (Ethmozine)
Beta Adrenergic Blockers (Class II) – see below
Action Potential-Prolonging Agents (Class III)
- Bretylium Sotalol (Betapace)
- Dofetilide (Tikosyn)
Calcium Channel Blockers – see below
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Metoprolol (Lopressor, Toprol)
- Nadolol (Corgard)
- Pindolol (Visken)
- Propranolol (Inderal)
- Timolol (Blocadren)
- Carvedilol (Coreg)
- Nebivolol (Bystolic)
- Enalapril (Vasotec)
- Lisinopril (Zestril)
- Quinapril (Accupril)
Angiotensin II receptor Blockers
- Candesartan (Atacand)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Valsartan (Diovan
- Ticlopidine (Ticlid)
- Clopidogrel (Plavix)
- Heparin
- Warfarin (Coumadin)
- Amlodipine (Norvasc, Lotrel)
- Felodipine (Plendil)
- Isradipine (Dynacirc)
- Nicardipine (Cardene)
- Nifedipine (Adalat, Procardia)
- Verapamil (Calan, Isoptin)
- Diltiazem (Cardizem, Tiazac)
- Atorvastatin (Lipitor)
- Pravastatin (Pravachol)
Over-the-Counter Medications
Prescription Medications
Opioid Analgesics (Pain Medication)
Morphine is given to relieve chest pain. Possible side effects include:
- Constipation
- Nausea and vomiting
- Itching
- Dizziness
- Sedation
Nitrates
Nitrates help relieve chest pain by dilating the arteries, which allows more blood to flow to the heart muscle. Early in treatment nitroglycerin may be administered as a tablet placed under the tongue or infused through a vein. Long-term, nitroglycerin may be given on a regular basis through a patch, paste, or orally to control chronic chest pain.
Possible side effects include:
- Low blood pressure
- Headache
Thrombolytic Agents
- Tissue plasminogen activator (tPA)
- Streptokinase
A drug to dissolve or break up blood clots in the coronary artery may be given intravenously. Early treatment, within three hours of the heart attack, offers the best chance for good results. The patient’s medical history, age, and condition may prevent treatment with clot-busting drugs.
Possible side effects include:
- Stroke
- Hemorrhage
Antiarrhythmic
Sodium Channel Blockers (Class I)
- Procainamide (Procan-SR, Pronestyl)
- Quinidine (Cardioquin, Quinidex Extentabs)
- Disopyramide (Norpace)
- Lidocaine
- Flecainide (Tambocor)
- Tocainide (Tonocard)
- Amiodarone (Cordarone)
- Mexiletine (Mexil)
- Propafenone (Rythmol)
- Moricizine (Ethmozine)
Beta Adrenergic Blockers (Class II)—see below
Action Potential-Prolonging Agents (Class III)
- Bretylium
- Sotalol (Betapace)
- Dofetilide (Tikosyn)
Calcium Channel Blockers—see below
During a heart attack, damage to the heart muscle can increase the risk of abnormal heart rhythms. Unstable heart rhythms can prevent the heart from effectively pumping blood, and if serious, lead to sudden death. Antiarrhythmic drugs help the heart beat more normally, usually by suppressing abnormal beats or by regularizing the heart rate. There are a wide variety of drugs available to treat the various causes of abnormal rhythms. In emergencies, some of these drugs are given intravenously. Oral forms of medication are used to treat more chronic arrhythmias. The main issue with these drugs is that unless the underlying rhythm problem can be corrected, they must be taken indefinitely. Also, one of the more unpredictable side effects of some of these medications is the risk of making the arrhythmia worse. Talk to your doctor about the specific side effects or warning signs to watch for based on the drug you are taking.
Beta-Blockers
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Metoprolol (Lopressor, Toprol)
- Nadolol (Corgard)
- Pindolol (Visken)
- Propranolol (Inderal)
- Timolol (Blocadren)
- Carvedilol (Coreg)
- Nebivolol (Bystolic)
Beta-blockers decrease demands on the heart and lower blood pressure. They may limit the amount of heart damage and help to prevent future heart attacks. They can also be used for their antiarrhythmic effects.
Possible side effects include:
- Low blood pressure
- Slow heart rate
- Fatigue
- Sexual dysfunction
ACE Inhibitors
- Enalapril (Vasotec)
- Lisinopril (Zestril)
- Quinapril (Accupril)
ACE inhibitors lower blood pressure and help lower mortality in people who sustain significant damage to their heart muscle.
Possible side effects include:
- Low blood pressure
- Headache
- Dizziness
- Cough
- Swelling
- Skin rashes
Angiotensin II receptor Blockers
- Candesartan (Atacand)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Valsartan (Diovan
Possible side effects include:
- Headache
- Dizziness
- Lightheadedness
- Nasal congestion
- Back and leg pain
- Diarrhea
Antiplatelet Drugs
- Ticlopidine (Ticlid)
- Clopidogrel (Plavix)
Antiplatelet drugs help prevent the blood from clotting. They may be given when aspirin cannot be used. They may also be given in conjunction with aspirin to people who have had an angioplasty.
Possible side effects include:
- Bleeding
- Diarrhea
- Stomach upset
Anticoagulants
Anticoagulants help to prevent the blood from clotting. It is often given to patients during heart procedures or after a clot-busting drug treatment.
Possible side effects include:
- Internal bleeding
- Stroke
Calcium Channel Blockers
- Amlodipine (Norvasc, Lotrel)
- Felodipine (Plendil)
- Isradipine (Dynacirc)
- Nicardipine (Cardene)
- Nifedipine (Adalat, Procardia)
- Verapamil (Calan, Isoptin)
- Diltiazem (Cardizem, Tiazac)
Calcium channel blockers lower blood pressure and slow the heart rate. These may be given to patients who cannot take beta-blockers. They can also be used for their antiarrhythmic effects. Recent research indicates they are not helpful in the early treatment of heart attack, nor do they prevent future heart attacks.
Possible side effects include:
- Low blood pressure
- Dizziness
- Constipation
Statins
- Atorvastatin (Lipitor)
- Pravastatin (Pravachol)
- Lovastatin (Mevacor)
- Simvastatin (Zocor)
- Fluvastatin (Lescol)
Statins are drugs that help to lower blood cholesterol levels. They may be prescribed along with a low cholesterol diet in patients with elevated blood cholesterol levels. In a recent clinical trial of daily atorvastatin after recent stroke or "mini-stroke" (and no known coronary heart disease), atorvastatin reduced the risk of repeat stroke or heart attack. *
Possible side effects include:
- Liver damage
- Muscle pain
Over-the-Counter Medications
Aspirin
Aspirin may be given by emergency medical personnel and continued after admission to the hospital. Aspirin helps prevent clotting and reclosing of the artery. Aspirin should generally be taken with food to decrease stomach upset.
Possible side effects include:
- Stomach upset
- Bleeding and stroke
- Bronchospasm
Additional drugs may be given depending on your condition and response to treatment.
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
- Take them as directed—not more, not less, not at a different time.
- Do not stop taking them without consulting your doctor.
- Don’t share them with anyone else.
- Know what effects and side effects to expect, and report them to your doctor.
- If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
- Plan ahead for refills so you don’t run out.
References:
Ryan T, Antman E, Brooks NH. For: American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA guidelines for the management of patients with acute myocardial infarction. Circulation . 1999;100:1016-1030.
American Heart Association website. Available at: http://www.americanheart.org . Accessed August 14, 2008.
American Medical Association website. Available at: http://www.ama-assn.org/ .
USP DI. 21st ed. Micromedex; 2001.
Mayo Clinic heart Center website. Available at: http://www.mayoclinic.com/health/heart-disease/HB00059 . Accessed January 29: 2007.
Ovbiagele B. Statin therapy after stroke or transient ischemic attack-a new weapon in our secondary stroke prevention arsenal? Nat Clin Pract Neurol. 2007 Jan 23; [Epub ahead of print].
*Updated section on Statins on 9/19/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Amarenco P, Bogousslavsky J, Callahan A, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med . 2006;355(6):549-559.
Last reviewed July 2008 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.