The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries, which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease that narrows one or more of these arteries can block blood flow, causing chest pain (angina) or an acute coronary syndrome (see also Overview of Coronary Artery Disease).
In an acute coronary syndrome, sudden blockage in a coronary artery greatly reduces or cuts off the blood supply to an area of the heart muscle (myocardium). The lack of blood supply to any tissue is termed ischemia. If the supply is greatly reduced or cut off for more than a few minutes, heart tissue dies. A heart attack, also termed myocardial infarction (MI), is death of heart tissue due to ischemia.
There are many different reasons doctors give medications to people with coronary artery disease:
To relieve chest pain by reducing the heart's workload and widening arteries (usually nitrates)
To prevent angina and acute coronary symptoms from occurring (beta-blockers, calcium channel blockers, and sometimes ranolazine)
To prevent and reverse coronary artery narrowing from atherosclerosis (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], statins, and antiplatelet medications)
To open a blocked artery (clot-dissolving medications, anticoagulants)
Often, oxygen is given through nasal prongs or a face mask. Providing more oxygen to the heart can help keep heart tissue damage to a minimum.
Medications Used to Treat Coronary Artery Disease*
Examples | Some Side Effects | Comments |
|---|---|---|
Angiotensin-converting enzyme (ACE) inhibitors | ||
Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril | Cough, usually dry and metallic Rash Rarely, a severe allergic reaction (angioedema) Possibly worsening of kidney function when people already have kidney disease or when the artery to one of the kidneys is greatly narrowed | These medications lower blood pressure and treat heart failure and prevent kidney damage in people with high blood pressure or diabetes. They also benefit people who have had heart attacks. People who have high blood pressure, heart failure, or prior heart attacks and who are treated with an ACE inhibitor live longer than people who do not take an ACE inhibitor. |
Angiotensin II receptor blockers (ARBs) | ||
Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan | Similar to ACE inhibitors, but cough is much less common | These medications have equivalent effects and benefits to those of ACE inhibitors. In people with severe high blood pressure or heart failure, these medications may be used in combination with an ACE inhibitor. |
Other medications | ||
Ranolazine | Dizziness, headache, constipation, and nausea | This medication is used to treat people who continue to have symptoms of angina despite treatment with other drugs. |
Ivabradine | Blurred vision, chest discomfort, slow or fast heartbeat,headache, dizziness or fainting | This medication is used to treat symptoms of angina in some people who cannot take beta-blockers. |
Anticoagulants | ||
Argatroban Apixaban Bivalirudin Dabigatran Dalteparin Enoxaparin Fondaparinux Heparin Rivaroxaban Tinzaparin Warfarin | Bleeding, especially when used with other medications that have a similar effect (such as aspirin and other nonsteroidal anti-inflammatory drugs) | These medications prevent blood from clotting. They are used to treat people who have unstable angina or who have had a heart attack. |
Antiplatelet medications | ||
Aspirin Clopidogrel Prasugrel Ticagrelor Ticlopidine | Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants) With aspirin, stomach irritation With ticlopidine and less so with clopidogrel, a small risk of reducing the white blood cell count | These medications prevent platelets from clumping and blood clots from forming. They also reduce the risk of a heart attack. They are used to treat people who have stable or unstable angina or who have had a heart attack. Aspirin is taken as soon as a heart attack is suspected. People with an allergy to aspirin may take clopidogrel or ticlopidine as an alternative. |
Beta-blockers | ||
Atenolol Bisoprolol Carvedilol Metoprolol | Spasm of airways (bronchospasm) Abnormally slow heart rate (bradycardia) Heart failure Cold hands and feet Insomnia Fatigue Shortness of breath Depression Raynaud syndrome Vivid dreams Hallucinations Sexual dysfunction With many beta-blockers, an increase in the triglyceride level and a decrease in the level of high density lipoprotein (HDL), which is the "good" cholesterol | These medications reduce the workload of the heart and the risk of a heart attack and sudden death. They are used to treat people who have stable or unstable angina or microvascular angina or who have had a heart attack. |
Calcium channel blockers | ||
Amlodipine Diltiazem Felodipine Nifedipine (sustained-release only) Verapamil | Dizziness Fluid accumulation (edema) in the ankles Flushing Headache Heartburn Enlarged gums Abnormal heart rhythms (arrhythmias) With verapamil, constipation With short-acting, but not long-acting, calcium channel blockers, possible increased risk of death due to heart attack, especially in people who have unstable angina or who have had a heart attack recently | These medications prevent blood vessels from narrowing and can reverse artery spasm. Diltiazem and verapamil reduce the heart rate. Calcium channel blockers are used to treat people who have stable angina. |
Glycoprotein IIb/IIIa inhibitors (a type of antiplatelet medication) | ||
Abciximab Eptifibatide Tirofiban | Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants or thrombolytic medications) Reduction of the platelet count | These medications prevent platelets from clumping and blood clots from forming. They may be used to treat people who have unstable angina, particularly those who are undergoing percutaneous coronary intervention after a heart attack. |
Nitrates | ||
Isosorbide dinitrate Isosorbide mononitrate Nitroglycerin | Flushing Headache Temporarily fast heart rate (tachycardia) | These medications relieve angina, prevent episodes of angina, and reduce the risk of a heart attack and sudden death. (However, risk reduction is much less than that with beta-blockers.) They are used to treat people who have stable or unstable angina or microvascular angina. For these medications to remain effective over the long term, people need to go 8 to 12 hours without taking the medication each day. |
Opioids | ||
Morphine | Low blood pressure when a person stands Constipation Nausea Vomiting Confusion (especially in older adults) | In some people who have had a heart attack, these medications are used to relieve anxiety and pain if the pain persists despite use of other medications. |
PCSK-9 inhibitors | ||
Alirocumab Evolocumab | Few serious side effects | These medications are used to lower LDL-C, which is the "bad" cholesterol, in patients not at target LDL-C levels. They are used alone or in combination with other lipid-lowering medications (eg, statins, ezetimibe) for the treatment of adults with primary hyperlipidemia (including familial hypercholesterolemia), including people who have trouble tolerating other medications that lower cholesterol |
Statins† | ||
Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin | Occasionally, muscle aches and pains, but rarely severe muscle pain (myositis) Rarely, liver damage, but not more commonly than in people who are not taking the medication | These medications lower cholesterol levels and help to heal damaged arteries, decreasing the chance of having a first or repeated heart attack or stroke. |
Thrombolytic drugs | ||
Alteplase Anistreplase Reteplase Streptokinase Tenecteplase | Rarely, bleeding within the brain (intracerebral hemorrhage) or the digestive tract | These medications dissolve blood clots. They are used to treat people who have had a heart attack. |
* Doctors may use different combinations of medications depending on the type of coronary artery disease the person has. | ||
† Also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors. | ||
Nitrati
Most people are given nitroglycerin, which relieves pain by lowering blood pressure, which reduces the workload of the heart, and possibly by dilating arteries. Usually, it is first given under the tongue, then intravenously.
Mofini
Most people who have had a heart attack are experiencing severe discomfort and anxiety. Morphine has a calming effect and reduces the workload of the heart. It is given when nitroglycerin cannot be used or is not effective; however, some data suggest it may interact with antiplatelet medications and reduce their effectiveness and may slightly increase the risk of death.
Vizuizi vya beta
Because decreasing the heart’s workload also helps limit tissue damage, a beta-blocker is usually given to slow the heart rate. Slowing the rate enables the heart to work less hard and reduces the area of damaged tissue.
Vizuizi vya njia ya kalsiamu
Calcium channel blockers prevent blood vessels from narrowing (constricting) and can counter coronary artery spasm. All calcium channel blockers reduce blood pressure. Some of these medications, such as verapamil and diltiazem, may also reduce the heart rate. This effect can be useful to many people, especially those who cannot take beta-blockers or who do not get enough relief from nitrates.
Vizuizi vya kimeng'enya kinachobadilisha angiotensini na vizuizi vya mapokezi vya angiotensini II
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can reduce heart enlargement and increase the chance of survival for many people. Therefore, these medications are usually given in the first few days after a heart attack and prescribed indefinitely.
Statins
Statins have long been used to help prevent coronary artery disease, but they also have short-term benefit for people with an acute coronary syndrome. Doctors give a statin to people who are not already taking one.
Dawa za kuzuia sahani za damu
People who think they may be having a heart attack should chew an aspirin tablet immediately after calling an ambulance. If aspirin is not taken at home or given by emergency personnel, it is immediately given at the hospital. This therapy improves the chances of survival by reducing the size of the clot (if present) in the coronary artery. People may also be given other types of antiplatelet medications such as clopidogrel, ticlopidine, or ticagrelor taken by mouth, or glycoprotein IIb/IIIa inhibitors given by vein (intravenously).
Dawa za kuyeyusha matone ya damu
Clot-dissolving medications (thrombolytic medications) are given intravenously to open the arteries if percutaneous coronary interventions cannot be done within 90 minutes after the person arrives at the hospital.
Dawa ya kuzuia usagaji wa damu
Most people are also given an anticoagulant, such as heparin, to help prevent the formation of additional blood clots.
Ranolazine na ivabradine
Ranolazine and ivabradine are alternative therapies for people with angina that does not respond to the usual therapies (for example, nitrates or morphine).
kizuizi cha PCSK-9
This class of medication is used for people whose levels of low-density lipoprotein cholesterol (LDL-C), which is the "bad" cholesterol, is not at the target level. PCSK-9 inhibitors, such as alirocumab or evolocumab, are used alone or in combination with other lipid-lowering medications (for example, statins or ezetimibe) for the treatment of adults with primary hyperlipidemia, including familial hypercholesterolemia. They can be particularly useful for people who have difficulty tolerating the side effects of other medications that lower cholesterol levels.
