medicines for your heart - Medical Education · Taking medicines for your heart 5 What is coronary...

Taking medicines for your heart

Information for South Asians

British Heart Foundation2

This booklet is available in Bengali, Gujarati, Hindi, Punjabi andUrdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages.

About this booklet

This booklet describes the different drugs prescribed for people whohave a heart condition. It explains why you have been given eachdrug and how it works. It also describes the possible side effects.

The information in this booklet is not a substitute for the advice yourdoctor may give you based on his or her knowledge of your condition.

ContentsWhat do heart drugs do? 4

Why are there so many different drugs? 6

How are heart drugs taken? 7

How often do I need to take the drugs? 7

What are the drugs for? 8

How does my doctor choose which drugsto give me, and the dose? 12

Do the drugs have any side effects? 14

Types of drugs 15

ACE inhibitors 15

Angiotensin II antagonists 16

Anti-arrhythmic drugs 17

Anticoagulants 18

Anti-platelet drugs (such as aspirin) 20

Beta-blockers 21

Calcium channel blockers (calcium antagonists) 22

Cholesterol-lowering drugs 23

Diuretics 25

Nitrates 26

Potassium channel activators 28

Thrombolytic drugs (‘clotbusters’) 28

Other drugs used for high blood pressure 29

For more information 31

Index 32

Your comments please 33


What do heart drugs do?

How the heart worksYour heart is a muscle about the size of your fist.It beats about 70 times a minute, pumping bloodaround your body.

When the blood leaves the heart, it goes to yourlungs where it picks up oxygen. The oxygen-rich blood returns to your heart and is then pumped through a system of arteries to provide oxygen to all the organs of your body. The blood then returns to the heartthrough the veins and is thenpumped back to the lungs again. This is called the circulation.

Your heart muscle gets its own supply of blood from the coronaryarteries. These are blood vessels on the surface of your heart.

The heart

right coronaryartery

arteries

heart

arteries

left coronaryartery

Taking medicines for your heart 5

What is coronary heart disease?Over time, the walls of your arteries can slowlybecome furred up with a fatty material calledatheroma. Coronary heart disease is when thecoronary arteries become so narrow that theblood supply to your heart muscle is restricted. Thiscan cause angina (chest pain). Or, if a coronaryartery becomes completely blocked, it can cause aheart attack. We describe the symptoms of anginaand heart attack on page 8.

There are several things you can do to help yourself,even if you already have heart disease. Theseinclude: eating healthily (eating less saturated fat,and more fruit and vegetables), being morephysically active, keeping to a healthy weight and, if you smoke, stopping smoking. For more information on these, see our booklet Looking after your heart.Your doctor may also prescribe some drugs for you.

So what do the drugs do?Some drugs are to relieve pain. Others help yourheart work more efficiently, or improve your circulation. It is a bit like a mechanic tuning anengine which is not working as well as it should.

Atheroma

artery wall

blood withinthe artery

atheroma(fatty deposits)

building up

Fat deposits develop,restricting blood flow

through the artery.

Why are there so many different drugs?

Many different drugs are used to treat heart disease, but they all belong to a few main types. We describethese on pages 15-29. Each type of drug has one ‘official’name but it may also be produced under one or moretrade names.



How are heart drugs taken?Drugs can be taken in different ways.

Tablets or capsules -- Sometimes drugs are givenas tablets or capsules which you swallow.Sometimes you have to keep a tablet under yourtongue until it dissolves.

Aerosol spray -- You spray the drug into yourmouth or under your tongue.

Self-adhesive patch -- You put a patch containing the drug on your skin. The drug is absorbed through your skin.

Injection -- Some drugs are injected into a vein, or into your buttock or thigh, or just under your skin. Or they may be given in a diluted form through an intravenous drip.

How often do I need to take the drugs?

Some drugs need to be taken only when you get asymptom such as angina.

Other drugs -- for example drugs to prevent angina, or to treat high blood pressure -- need to be taken regularly, as your doctor has prescribed. In most cases, you need to take the tablets once or twice a day, but sometimes more frequently.

It can be dangerous to stop taking your tablets without medical advice. For example, it might cause a sudden change in your blood pressure.


What are the drugs for?

Drugs may be used to treat the following heartconditions. Some drugs are used for more than one condition.

AnginaHeaviness or tightness in the centre of the chest,which may spread to the arms, neck, jaw, face, back or stomach. Or it may affect just the neck, jaw, arm orstomach. Symptoms usually go away within about 10--15 minutes.

Angina can be brought on by physical activity oremotional stress. In severe cases it can happenwhile you are resting. This is called unstable angina.Angina is caused when the heart muscle is notgetting enough oxygen.

Some examples of drugs for people who have angina• Beta-blockers • Calcium channel blockers • Nitrates • Potassium channel activators

We give more information about all these drugs on pages 15--29.

Heart attackAlso called myocardial infarction

orcoronary thrombosis.

The discomfort or pain of a heart attack is similarto angina but is sometimes more severe. There mayalso be sweating, light-headedness, feeling sick, orshortness of breath. Symptoms usually last morethan 15 minutes and are not completely relieved byresting or using a nitrate spray.


A heart attack is usually due to a blood clot blocking acoronary artery which has been previously narrowedby a gradual build-up of fatty material (atheroma)within its walls.

Some examples of drugs for people who have had a heart attack

• Thrombolytics (also called ‘clotbusters’)• ACE inhibitors • Aspirin • Beta-blockers• Cholesterol-lowering drugs such as statins


High blood pressureAlso called hypertension.

Blood pressure is the pressure of the blood in yourarteries. If the blood pressure is persistently high, it canlead to coronary heart disease, heart failure, stroke, andkidney damage.

Some examples of drugs for people with high blood pressure

• ACE inhibitors • Alpha-blockers • Beta-blockers • Calcium channel blockers • Diuretics



Heart failureWhen the heart is not pumping well, this can cause breathlessness and fatigue, and fluid may build upin the lungs and feet.

Some examples of drugs for people with heart failure

• ACE inhibitors• Beta-blockers• Diuretics• Digoxin


Disorders of heart rhythmAlso called arrhythmias.

When the heart is beating irregularly, or too fast or too slowly.

Some examples of drugs for people with disorders of heart rhythm

• Anti-arrhythmic drugs• Anticoagulants• Beta-blockers• Calcium channel blockers• Digoxin



Valvular heart diseaseDiseased or damaged heart valves affect the flowof blood through the heart. This causes a strain on theheart and circulation.

Some examples of drugs for people with valvularheart disease

• ACE inhibitors • Digoxin • Diuretics• Anticoagulants

We give more information about all these drugs onpages 15--29.

Preventing coronary heart diseaseDrugs may also be used to control some of the factors that can increase your risk of coronary heartdisease -- especially if changing your lifestyle willnot be enough.

Some examples of drugs to reduce the risk ofcoronary heart disease

• Cholesterol-lowering drugs• Drugs to lower high blood pressure• Aspirin• ACE inhibitors

We give more information about all these drugs onpages 15--29.


How does my doctor choose whichdrugs to give me, and the dose?

Your doctor has many different drugs to choose fromto treat your heart condition. He or she will choose theones which are most likely to be effective and safefor you.

People respond very differently to individual drugs. Forexample, one person may get side effects from a drug,while another person taking the same drug will notget any side effects. So it is difficult to know exactlywhich drug will best suit a particular patient.

The same applies to the dosage of drugs. Your doctormay need to find out the most suitable dosage for youby trying it out and getting feedback from you. You may need to have your blood pressure recordedregularly, or have blood tests, to find out the best dosefor you.


It can be dangerous to stop taking your tablets withoutmedical advice. For example, it might cause a suddenchange in your blood pressure.


Do the drugs have any side effects?

Most drugs used to treat heart disease are very safe.Dangerous side effects are rare. However, minor sideeffects happen quite often and you need to knowabout the more common ones. If you get minor sideeffects, you may still be able to continue taking thedrug, or your doctor may need to change it for another drug.

This booklet tells you about the side effects of different drugs, on pages 15-29. Your doctor or pharmacist should tell you about the common side effects of the drugs you are given. More informationabout possible side effects is given on the sheet thatcomes with each new packet of tablets. If you do notread English, ask a friend or relative, or a doctor or pharmacist, to translate for you.

Remember that these information sheets list all thepossible side effects. Most side effects are uncommon.

If you develop any symptoms or problems, they maybe a side effect of the drugs you are taking, rather than a sign of further heart trouble.

If you develop any new symptoms or problemsafter starting on a drug, it is important to tell your doctor about them.

What are they used for?ACE inhibitors are used to treat:• heart failure• high blood pressure• heart attack.

What do they do?They relax the blood vessels and helpimprove the flow ofblood to the heart muscle.

• A fall in blood pressure.• Skin rash. • A persistent, dry,

irritating cough.• Effects on the kidneys. • A major allergic reaction.

This happens to only a small number of people.

What are they? Other informationPossible unwanted effects

When you start takingthese drugs, you willhave your blood pressure checked regularly. You will alsoneed to have regularblood tests to checkthat your kidneys areworking well.

If you get a dry, irritating cough, tellyour doctor about it.He or she can prescribe anothermedicine called an ‘angiotensin II antagonist’ instead (see page 16).

ACE inhibitors Common examples are ramipril and enalapril.

Types of drugs

On pages 15--29 we give a list of the possibleunwanted effects. Most side effects are minor.Serious side effects are rare.



What are they used for?They are used to treathigh blood pressure.

What do they do?They act in a similar way to ACE inhibitors (see page 15) but do not cause the persistentdry cough that ACEinhibitors can sometimes cause.

Dizziness.


When you start taking these drugs,you will need tohave regular bloodtests to check thelevel of salts in yourblood and to checkthat your kidneys areworking well.

Angiotensin ll antagonists Common examples include losartan and valsartan.


What are they used for?Anti-arrhythmic drugsare used to treatarrhythmias (disorders of the heart rhythm).

What do they do?They help to controland regulate the heartrhythm.

Amiodarone

Digoxin Digoxin is sometimesused to treat ‘atrial fibrillation’-- when yourheart beats quickly andirregularly. It slows theheart but it does notrestore its regularrhythm, so you mayneed to take otherdrugs at first.

• Headache• Flushing• Dizziness • Stomach upsets

Rare side effects include disorders of the thyroid gland, lungs and liver.

• Loss of appetite• Nausea• Vomiting• Painful or

enlarged breasts• Palpitations• Fainting


Beta-blockers andcalcium channel blockerscan also help peoplewith abnormal heartrhythms. We describethese drugs on pages21 and 22.

You will need to haveregular blood tests andperhaps chest X-rays.Amiodarone tends to make the skin verysensitive to sunlight. So, if you are taking thisdrug, use a powerfulsunscreen cream whenyou are in the sun, andwear a hat.

Tell your doctor if youget any of these symptoms. He or shemay need to adjust your dosage.

You may need bloodtests to make sure thatyou have the correctlevel of drug in yourblood.

Anti-arrhythmic drugs Examples include amiodarone, digoxin, flecainide and propafenone.


What do they do?Anticoagulants help tostop clots in the bloodfrom forming.

What are they used for?Heparin is given, by injection, when there is an urgent need toprevent the blood fromclotting.

Warfarin (or another anticoagulant) is given,in tablet form, whenlong-term prevention ofclotting is needed -- forexample for people withheart valve disease orwith an irregular heartrhythm.

If you get any of the followingsymptoms it might bebecause your dose of anticoagulants is too high:• bleeding from cuts that

lasts for a long time• bleeding that does not

stop by itself• nose bleeds that last for

more than a few minutes• bleeding gums• red or dark brown urine• red or black stools• for women, heavier

bleeding during periods, or other vaginal bleeding.

If you are worried about any symptoms, contact your GPor anticoagulant clinic, or thecasualty department at yourlocal hospital. Take yourdosage record card and anyother medications with you.


You will need regularblood tests to makesure that you are getting the rightamount of anticoagulants.

If you are takinganticoagulants, alwayscarry an anticoagulantcard, and tell any doctors or nursesabout your anticoagulant treatment.

Oral anticoagulants interact with many medicines. So checkwith your doctor or pharmacist before you take any other drugs.

Alcohol increases theeffect of warfarin, so it is important toavoid excessive alcohol drinking.

Anticoagulants


Some drugs are to relieve pain. Others help your heart workmore efficiently, or improve your circulation.


What are they used for?Aspirin (or other anti-platelet drugs) are given to most people who have coronary heart disease,unless there are strong reasons for not giving it.

What do they do?They help to reduce blood clotting.

• Indigestion• Nausea• VomitingThese stomach problems can be reduced by using special preparations of the drug.

There are some more seriouseffects but they are not common. These are:• bleeding from the stomach,

and• asthma attacks.


Your doctor may offeryou an anti-plateletdrug called clopidogrel,if he or she feels thataspirin does not suit you.

Anti-platelet drugs (such as aspirin)


What do they do?Beta-blockers prevent theheart from beating as quickly and forcefully asusual when you exercise or suffer stress.

What are they used for?Beta-blockers are used:• to prevent angina

attacks (but they work too slowly to help relieve an attack of angina)

• to control high blood pressure

• to treat abnormal heart rhythms

• to reduce the risk of another heart attack in people who have already had one

• to treat heart failure.

• Tiredness• Cold hands and feet • Vivid dreams

Less common side effects include:• feeling sick • diarrhoea• skin rash • impotence • nightmares • dizziness.


Don’t stop taking beta-blockers suddenly withoutmedical advice.Coming off them tooquickly can make angina worse, or bringon a heart attack.

If you have asthma orsuffer from wheezing,your doctor will needto choose your beta-blocker carefully as some types tend to narrow the air passages.

Beta-blockersCommon examples are atenolol, metoprolol and popranolol.


What do they do?These drugs help thearteries to relax andwiden. This means thatmore blood can getthrough to the heart, andthe heart doesn’t have towork so hard to pumpblood around the body.

What are they used for?Calcium channel blockersare used to treat:• angina (often together

with other drugs)• high blood pressure• abnormal heart

rhythms.

• Flushing• Headache• Tiredness• Swelling of the ankles• Indigestion

Serious side effects areuncommon.


If you have asthma,calcium channel blockers may be a suitable alternativefor you if you cannot take other anti-angina or bloodpressure loweringdrugs because ofyour asthma.

Calcium channel blockers (calcium antagonists) Common examples are diltiazem, verapamil and nifedipine.


What do they do?These drugs help toreduce the amount ofcholesterol in the blood.Cholesterol is a fattysubstance which ismainly made in thebody. The liver alsomakes it from the saturated fats in food.Cholesterol plays a vitalrole in how the cells inthe body work. But toomuch cholesterol in theblood can increase yourrisk of getting coronaryheart disease.

StatinsStatins are the maintype of drugs used to reduce cholesterollevels.

If statins are not suitablefor you, you may begiven a different drug.

Indigestion.

A rare side effect of statinsis inflammation of the muscles (myositis). A blood test can help diagnose this problem.


Before starting statins,you may have a bloodtest to check how wellyour liver is working.This test will berepeated regularlywhile you are havingtreatment, to makesure that the statinsare not affecting your liver.

Tell your doctor if youhave any unexpectedmuscle pains, tendernessor weakness.

Cholesterol-lowering drugs Also called ‘lipid-lowering drugs’.


There are several things you can do to help yourself,even if you already have heart disease. Theseinclude: eating healthily (eating less saturated fat, and more fruit and vegetables), being morephysically active, keeping to a healthy weightand, if you smoke, stopping smoking.


What are they used for?Diuretics are used to treat:• heart failure • high blood pressure.They are often used withother drugs.

What do they do?If your body is retainingtoo much fluid (whichcan be a problem for people with high bloodpressure and heart failure), this could mean that your heart is not pumping as efficiently as it should. Diuretics increase the output of water and saltin the urine.

There are three maintypes of diuretics:• thiazide• loop diuretics • potassium sparing

diuretics.

• People with gout may find that some diuretics make their condition worse.

• Spironolactone, a potassium sparing diuretic which is used to treat heart failure, may makeyou feel sick.

• People with diabetes may find that some diuretics raise their blood sugar level.


Eating too much saltand salty food cancounteract the effectof the diuretics. So ifyou are taking thesedrugs, avoid saltyfoods, and don’t addany salt to food during cooking or at the table.

If you are taking thiazide or loopdiuretics, you willneed to have bloodtests from time totime to check thelevel of potassium (a chemical in yourblood). If this is getting low, you willbe given potassiumsupplements. Or your doctor may give you a potassium sparing diuretic instead.

Diuretics Also called ‘water tablets’.


What do they do?Nitrates relax the muscles inthe walls of the arteries andveins and make them wider.

What are they used for?Nitrates are used torelieve the pain of angina, or to prevent predictable attacks.You can take them justbefore doing somethingthat usually brings on an angina attack.

Glyceryl trinitrate tabletsAlso called GTN, trinitrateor nitroglycerin tablets

Tablets of glyceryl trinitrate, put under thetongue, relieve anginaquickly. They are particularly effective when used to prevent a predictable attack.

Let the tablets dissolveunder your tongue. They are not effective if you swallow them.

Nitrates can cause:• headache• flushing• dizziness• faintness.

These symptoms are mostcommon with glyceryl trinitrate tablets. The symptoms tend to lessenwith continued use.

You may get a throbbingheadache when you first takethese tablets. This usuallygoes away after you havebeen taking the tablets for a while.

These tablets may also causeflushing, dizziness or fainting,so sit down when taking yourfirst tablet.


The tablets losetheir strengthquite quickly, so replace themwith a fresh supply after six to eight weeks.

Nitrates


Glyceryl trinitrateaerosol sprayYou need to spray oneor two doses under your tongue. There is no need to shake the canister before spraying.

Oral nitratesIsosorbide mononitrate and dinitrate are effective for preventingangina attacks.

Nitroglycerin skin patchesThese can help prevent angina.

Other informationPossible unwanted effects

The contents of the canister become ineffective after about two years. So, if the canister has passed its ‘use by’ date, ask your doctor for a replacement,even if you haven’t usedthe whole canister.

If you find that the tabletsbecome less effective, tellyour GP. These drugs maylose their effectiveness if taken at regular intervals.If this happens, leave alonger interval betweentwo of the doses each day.

The skin patches may beless effective if they areused continuously for a24-hour period. So it mayhelp to leave the patchesoff for several hours ineach 24-hour period.


What are they used for? To relieve angina.

How do they work?These drugs work in a similar way to nitrates --they relax the walls of the coronary arteries and so improve blood flow.

• Headache (when you first take them)

• Flushing• Indigestion • Dizziness


Unlike nitrates, potassiumchannel activators do not appear tobecome less effectivewith continued use.

Potassium channel activatorsFor example nicorandil.

What are they used for?Thrombolytic drugs areused to treat heart attack.

The sooner they are givenafter the beginning ofthe attack, the better. The most commonlyused drug is streptokinase,given as an infusiondirectly into a vein.

What do they do?Thrombolytic drugsdissolve the clot that is blocking the artery.

These drugs can sometimescause serious bleeding, sobefore a doctor gives themhe or she must be reasonablysure that the patient doesnot have a high risk ofbleeding (for example if the person has recently had surgery or a stroke).


If you receive thrombolytic drugs,you should be given a card to carry withyou, describing thetype of thrombolyticdrug given and whenit was given.

If the thrombolytic was streptokinase or anistreplase, you shouldnot have another doseof it. If you have anotherheart attack, a differentthrombolytic drug canbe given.

Thrombolytic drugs Also called ‘clotbusters’.


Alpha-blockers For example prazosin, doxazosin and terazosin

Methyldopa

Moxonidine

• A large fall in blood pressure (when you first use them)

• Tiredness

• Dry mouth• Drowsiness. This can

interfere with skilled tasks including driving.

• Dry mouth• Tiredness• Dizziness.


Other drugs used for high blood pressure

High blood pressure can usually be controlled successfully with diuretics, beta-blockers, calciumchannel blockers, or ACE inhibitors. (These aredescribed on pages 25, 21, 22 and 15.) But sometimes these are not enough, or they may have unacceptable side effects, so otherdrugs -- such as alpha-blockers, methyldopa or moxonidine -- are added or given instead.


Medicines I need to take What they’re for

Morning

Afternoon

Evening

Many new and powerful drugs are now availablefor treating people with heart disease -- both torelieve pain and to help your heart work moreefficiently. If you develop any symptom or problem,it may be a side effect of the drugs you are takingrather than a sign of further heart trouble. It isimportant to tell your doctor about any symptomsthat you have after starting on a drug.


For more informationBookletsLooking after your heartAvailable in Bengali, Gujarati, Hindi, Punjabi, Urdu and English.

The following booklets are available in English only:

Eating for your heart Reducing your blood cholesterolDiabetes and your heartPhysical activity and your heartSmoking and your heartBlood pressure

You can order these booklets through our website.The address is bhf.org.uk

The British Heart Foundation (BHF) also producesother educational materials that may be of interest.To find out about these, or to order your Publicationsand Videos catalogue, please go to bhf.org.uk/publications or call the BHF Orderline on 0870 6006566 or email [email protected]. Many of our publications are downloadable frombhf.org.uk/publications.

Our publications are free of charge, but we would welcome a donation.

Heart health

magazineHeart health is a free magazine, produced by theBritish Heart Foundation especially for people withheart conditions. The magazine, which comes outfour times a year, includes updates on treatment,medicines and research and looks at issues relatedto living with heart conditions, like healthy eatingand physical activity. It also features articles on topics such as travel, insurance and benefits. To subscribe to this free magazine, call 0870 600 6566.


ACE inhibitors 15

alpha-blockers 29

amiodarone 17

angina 5, 8

angiotensin II antagonists 16

anti-arrhythmic drugs 17

anticoagulants 18

anti-platelet drugs 20

arrhythmias 10

aspirin 20

atenolol 21

beta-blockers 21

blood pressure 9, 29

calcium antagonists 22

calcium channel blockers 22

cholesterol-lowering drugs 23

clopidogrel 20

clotbusters 28

digoxin 17

diltiazem 22

diuretics 25

enalapril 15

flecainide 17

glyceryl trinitrate 26, 27

GTN 26

heart attack 5, 8

heart failure 10

heart rhythm disorders 10

heparin 8

high blood pressure 9, 29

hypertension 9, 29

lipid-lowering drugs 23

loop diuretics 25

losartan 16

methyldopa 29

metoprolol 21

moxonidine 29

nifedipine 22

nitrates 26, 27

nitroglycerin 26, 27

popranolol 21

potassium channel activators 28

potassium sparing diuretics 25

propafenone 17

ramipril 15

statins 23

streptokinase 28

thiazide 25

thrombolytic drugs 28

thrombolytics 28

valsartan 16

valvular heart disease 11

verapamil 22

warfarin 18

water tablets 25

Index

Your comments please

We would be very interested to hear your views about this booklet.Please fill in this form and send it to:British Heart FoundationFREEPOST WD51314 Fitzhardinge StreetLondon W1E 1JZ

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Have your sayWe would welcome your comments to help us produce the best informationfor you. Why not let us know what you think? Contact us via the websitebhf.org.uk/yoursay

AcknowledgementsThe British Heart Foundation would like to thank all the following people fortheir work on this booklet:• the patients who commented on the text and design• Professor Raj Bhopal• Dr Sandeep Gupta, and• Dr Shahid Khan.

Heart Information Line: 08450 70 80 70(a local rate number)

An information service for the public and healthprofessionals on issues relating to heart health

British Heart Foundation14 Fitzhardinge StreetLondon W1H 6DHPhone : 020 7935 0185Fax : 020 7486 5820Website : bhf.org.uk

November 2004

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This booklet is available in Bengali, Gujarati, Hindi, Punjabi andUrdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages.

© British Heart Foundation 2004Registered Charity Number 225971

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