Optimal Medical Therapy

Non invasive Medical Treatment of Heart Disease


heart-termsMedical Treatment of Heart Disease

Recent studies have shown that alternatives to bypass surgery using modern medications is associated with a far lower morbidity and mortality. When medications are used in appropriate numbers and dosages, the patient is able to live a normal life without the risk of dying or having a heart attack.

We specialize in seeing patients who have been told they must undergo angiography, angioplasty, or bypass surgery immediately because their coronary arteries are blocked due to coronary artery disease. Such patients usually have been told that there are no other options for treatment, and that medical treatment with drugs will not work. Unfortunately, this is not true. Medical treatment not only can increase the blood flow to the heart muscle, and reduce the workload of the heart, but actually will prevent future heart attacks, and increase survival compared to angioplasty or bypass surgery. Surgery is rarely necessary, and even when necessary, never needs to be carried out immediately.

At Safe health we promote the use of modern medicines and other alternatives like exercise, weight loss, cessation of smoking and stress and blood pressure control for prevention of chest pain (angina) in whom heart disease have been detected.

Medications are prescribed to treat Heart Disease for preventing heart attacks to

  • Control the blood pressure
  • Prevent blood clots.
  • Lessen the work of your heart and improve your heart’s performance.
  • Prevent plaques by lowering cholesterol.
Antihypertensive Drugs — A group of drugs commonly prescribed to help lower blood pressure when appropriate diet and regular physical activity alone have not succeeded. They include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blocker (ARBs), vasodilators, alpha-blockers, beta-blockers, calcium channel blockers and central alpha-agonists. Many patients with high blood pressure may require more than one drug to achieve control. Some of these drugs may also be prescribed for heart failure and arrhythmia patients.

Angiotensin-Converting Enzyme (ACE) Inhibitors — A class of drugs used to treat high blood pressure and heart failure. ACE inhibitors stop the body’s production of angiotensin, which lowers blood pressure, increases blood flow to the heart and reduces the heart’s workload.
Examples: Ramipril, Enalapril. Lisinopril, Perindopril

Angiotensin II Receptor Blockers (or Inhibitors) (ARBs) — A class of drugs used to treat high blood pressure and heart failure. They do not interfere with the body’s production of angiotensin. They block the effects of angiotensin, preventing it from constricting the muscles around the blood vessels and narrowing the blood vessels. In this way they keep the coronary arteries open, which lowers blood pressure, increases blood flow to the heart and reduces the heart’s workload. (Also known as Angiotensin-2 Receptor Antagonists)
Examples: Losartan, Valsartan, Telmisartan, Candesartan

Sympathetic Nerve Inhibitors — A class of antihypertensive drugs that reduce blood pressure by inhibiting the sympathetic nerves from constricting blood vessels

Beta-Blockers (Beta-Adrenergic Blocking Agents) — A class of drugs that slow the heartbeat, lessen the force with which the heart muscle contracts and reduce blood vessel contraction in the heart, brain and throughout the body. They do this by blocking the action of beta-adrenergic substances such as adrenaline (epinephrine) in the “sympathetic” portion of the autonomic (involuntary) nervous system at the beta receptor. By blocking the action of the sympathetic nervous system on the heart, beta-blockers relieve stress on the heart. They may be used to treat abnormal heart rhythms (arrhythmias) and prevent abnormally fast heart rates (tachycardias) or irregular rhythms such as premature ventricular beats. Since they reduce the demand of the heart muscle for oxygen, they may be useful in treating angina (chest pain), which occurs when the oxygen demand of the heart exceeds the supply. They have become an important drug in improving survival after a person has had a heart attack. Beta-blockers are also used to treat high blood pressure and other heart conditions by reducing the heart rate and the heart’s output of blood.

Beta blockers have been shown to protect the heart from future heart attacks, and to reduce mortality in patients after a heart attack, when given on a chronic basis.

Egs – Atenolol, Metoprolol, Carvedilol, Bisoprolol,  Nebivolol

Calcium Channel Blockers (Calcium Antagonists) — A class of drugs that blocks the movement of calcium into the heart and blood vessel muscle cells. This causes the muscles to relax, lowering blood pressure, slowing the heart rate and decreasing oxygen demands of the heart. These medications lower blood pressure in patients with hypertension, but have little effect on normal blood pressure. Since they decrease the heart’s pumping strength, slow the heart rate and relax blood vessels, they are also used to treat other heart conditions, such as chest pain (angina) and abnormal heart rhythms (arrhythmias).

The advantage of the calcium channel blockers is its dual effect of lowering blood pressure, and increasing coronary blood flow. In general, the calcium channel blocking agents are highly effective, safe, and when used with care, can be depended upon to provide considerable benefit in most patients who are symptomatic.

Eg:  Diltiazem, Amlodipine

Diuretic (or Water Pill) — A drug that increases the rate at which urine forms by promoting the excretion of water and salts. This helps to relieve the heart’s workload and also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods. They are used to treat high blood pressure, congestive heart failure and some congenital heart defects.
Examples: Frusemide, Hydrochlorothiazide, Spironolactone

Antiplatelet Agents — A group of drugs used to keep blood clots from forming by preventing blood platelets from sticking together. They help prevent clotting in patients who have had a heart attack, unstable angina, ischemic strokes, transient ischemic attacks (TIA) and other forms of cardiovascular disease. They are usually prescribed preventively, when plaque buildup is evident in the arteries but there is not yet a large obstruction.
Examples: Aspirin, Clopidogrel 

Cholesterol-Lowering Drugs — Cholesterol-lowering drugs reduce LDL (“bad”) cholesterol, increase HDL (“good”) cholesterol and reduce triglycerides (a blood fat). Several classes of drugs are used to treat cholesterol including statins. People may be prescribed a “combination” therapy of drugs depending on their specific situations. Cholesterol-lowering drugs have been proven to reduce risks for heart disease. Due to potential side effects, patients who are taking most cholesterol-lowering drugs may need to have periodic liver function tests.
Examples: Atorvastatin, Simvastatin, Rosuvastatin.

Statins A group of drugs used to reduce elevated low-density lipoprotein (LDL) or “bad” cholesterol, which is associated with increased risk of cardiovascular disease. They work in the liver to prevent cholesterol from forming. They are also known as HMG CoA reductase inhibitors

Vasodilators — A group of drugs that cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessels to dilate. Nitroglycerin tablets are a form of vasodilator.

Nitroglycerine and nitrates have been used to treat patients with chest pain (angina pectoris) due to coronary artery disease for over 100 years. Two kinds of nitroglycerine drugs are available. One is nitroglycerine available in various forms including sublingual tablets, an ointment, patches and an oral spray. The other preparations are generally referred to as nitrates and consist of tablets that are chewed or swallowed. The most commonly used drug is Isordil or Sorbitrate.

Nitroglycerine and nitrates act by dilating the veins and arteries of the body. Since they preferentially enlarge the caliber of the veins, there is an increase in the blood carrying capacity on the venous side of the circulation. The result is a reduction in the amount of blood returning to the heart, a decrease in the volume of blood within the heart’s chambers with each heart beat, and a fall in pressure. In the same way that less air within a balloon brings about less expansion and tension, so is there less pressure and tension within the heart muscle. Accordingly, there is less compression of the microcirculation and an increase in coronary blood flow. Nitroglycerine and nitrates also relax the muscle within the walls of arteries throughout the body including the coronary vessels. Not only does this directly increase coronary blood flow, but it lowers blood pressure and the amount of work that the heart must do.

Examples: Glyceryl Trinitrate, Isosorbide Dinitrate, Isosorbide 5 Mononitrate, Nicorandil

What will Medical Treatment for Heart Disease do to the patient?

Good medical treatment of heart disease will allow a patient to be symptom free and enjoy a normal life span. But it depends entirely on the ability of the treating physician to identify the high risk patients who would benefit the most from a medical program. Patients who have symptoms will be greatly benefited. Those who are non-responsive to medical treatment program may require further evaluation and intervention.

It is those without symptoms who have the most to gain, and the most to lose if they are ignored. If you have coronary artery disease, your survival will largely depend upon whom you chose to treat you. So choose well!