MEDICINES FOR HEART

Drugs are chemicals used by the doctors to prevent or to cure diseases. They are definitely useful, but these days we are becoming over-dependent on them, especially in the field of cardiology. It is important for everyone to realize that these medicines are there only for maintenance/relief from symptoms and they can do nothing more than that. They do not cure the diseases and need to be continued indefinitely. These chemicals, in addition, have their side effects and are expensive. As a cardiologist and medical doctor I use the drugs to give relief to the patients. But alongwith them I also train them to follow a natural lifestyle so that they can reduce the use of these drugs in future. We have, at our disposal a wonderful mind-body machine that has a self healing and repairing capacity and I always like them to use that in the long run. I would also like you to use your common sense. If the foods, which contain fats, cause blockages in the heart arteries, then why should we use them? Non vegetarian foods contain cholesterol. Then why a heart patient, who has an on-going cholesterol deposit problem, should continue to consume non-vegetarian foods? On the contrary, fibers and anti oxidant foods have the ability to stop the cholesterol and fat deposits. So we must use them. Yoga, meditation, regular physical activity, stopping the consumption of tobacco and alcohol are immensely useful for a heart patient. I would like to make use of them to prevent and reverse heart disease.  

Fortunately most of the drugs do not cause side effects once they are withdrawn. At some places they are useful and almost sure to give relief. They are very useful in emergency conditions. They work instantly, while the  other natural processes are slow. This is where the drugs come in to fill up the gap. My training is medical science has given me an advantage that I can use the best of both – the advantage of the medicines and the goodness of natural healing processes.

WHEN THESE MEDICINES DO NOT REVERSE THE DISEASE BLOCKAGE, THEN WHY ARE THEY NECESSARY?

It is a myth that medicines can reverse blockages in the heart arteries. Yet, these medicines are necessary even when they are not reversing the disease. Till the time the blockage is reversed to a degree where it poses no risk to the patient there should be something to cover the risk and this job is done by the medicines. It is also given for symptomatic relief, to decrease pain, breathlessness or to decrease the clotting tendency of blood.

Medicines like Nitrates dilate the blood vessels (arteries), so as to increase the supply of blood to the area.

There are some medicines which decrease the oxygen requirement of the heart. In other words, if we do not allow the requirement of the heart to exceed a level when it experiences pain the it will not have any pain (angina). The example of these are Beta-blockers, Calcium channel blockers and ACE Inhibitors.

There is another group which inhibits those processes which make the blood more prone to clotting. (i.e. solidifying). They are the Blood Thinners.

Alongwith all these medicines another group can be useful which decreases the amount of cholesterol and other lipids dissolved in blood-the stuff blockages are made up of. This is to ensure that their production in the liver is curtailed.

WHY DO WE HAVE TO TAKE THESE MEDICINES AFTER REGULAR INTERVALS?

 When we swallow a medicine it goes to the stomach through the food pipe, where it first dissolves and then gets absorbed or else passes on to the intestine where it is absorbed. It then goes to the liver, where it undergoes some changes before finally entering into the blood where it maintains a concentration to produce some effects. All this takes 1-4 hours depending upon the medicine. This effect won’t stay there always. It remains there for some time, till the medicine is changed either into its byproducts or gets eliminated out of the body mainly by kidneys through urine.

Thus a medicine whose effect stays for 6 hours is required to be taken 4 times in a day, with effect for 8 hours is taken 3 times in a day, with effect for 12 hours is taken twice a day and with effect for 24 hours is taken one a day. When the effect starts reducing then another dose of medicine is to be taken to maintain the concentration in blood circulation, for the desired effect.

For example if the effect of Monotrate Tablet is for 12 hours approximately, then to maintain its effect it has to be taken twice in 24 hours.

These are some tablets with suffices CR, ER, TR, SR, i.e. controlled, extended or sustained release. These all are special preparations with a coating on them. They will not dissolve at once in the stomach (or intestine). Rather they dissolve gradually taking more time so that the effect is prolonged. Thus they should never be crushed or broken into two or chewed.

WHY SORBITRATE/ISORDIL BELOW THE TONGUE? HOW DOES IT EFFECT SO QUICKLY?

When placed below the tongue, it dissolves and is absorbed into the blood bypassing the food pipe, stomach, intestine and liver and reaches the heart where it produces its effect quickly i.e. Dilatation (widening) of arteries, leading to ease of pain. Thus in case of pain or shortness of breath, Sorbitrate should always be kept under the tongue and not be swallowed.

WHAT DOES A SORBITRATE OR ANOTHER MEDICINE OF THE SAME CLASS DO?

Sorbitrate is a Nitrate. This is one of the most common groups of medicines taken by a heart patient. When due to a blockage blood supply to a part is decreased, it leads to Angina (chest pain) or breathlessness or any other symptom.

When taken they dilate (widen) the blood vessels (arteries) so that oxygen rich blood can flow easily to that area. This reduces the pain.

Also, when veins dilate they hold more blood into them, thus reducing the load on the heart.

They are available and effective through various routes. They are available as tablets to be swallowed, chewed or be kept under the tongue. They can be injected or applied as patches on skin or sprayed (on or below the tongue). The ‘skin patch’ delivers the medicine slowly, through the skin.

Of all the Nitrates, Sorbitrate is the most widely known medicine, more popular to abort an episode of chest pain, when kept below the tongue. Patients should always keep Sorbitrate with them. It has saved so many heart attacks, and incapacitating chest pain.

The most common side effect of a few nitrates is a ‘headache’ which is because of dilatation of the arteries of the head, leading to a headache. But ‘tolerance’ has been observed to this headache, which means that after a few days the patient does not feel it anymore. If it does not subside then patient can be switched to another Nitrate which might not lead to a headache in that individual.

Other Uses: They can be used in other problems like Cyanide poisoning, Esophageal (food pipe) spasm.

MEDICINES WHICH REDUCE THE OXYGEN REQUIREMENT OF THE HEART

THE BETA BLOCKERS

Angina occurs an exertion. This happens because when we do physical exertion, e.g. walking, our body demands more oxygen. To meet this increased demand for oxygen the heart in turn has to increase its work to pump more blood. This would mean that the heart’s pumping rate has to increase (resting heart rate is approximately 70 beats per minute). This in turn increases the heart’s own demand for oxygen and as a result more blood flows through the coronaries. But in cases of coronary artery disease, where the patients have blockages, this increased demand is not met and thus angina occurs. It disappears an taking rest, s the heart rate comes down.

The increase in heart rate is brought about by a chemical which is released in the blood stream.

What if we decrease or do not allow increasing the requirement of the heart? This is another mode by which we can take care of pain.

During the times of stress, be it physical, mental or emotional, the body prepares to face it by secreting a chemical called Adrenaline. Adrenaline increases the heart rate, so that heart can work more, as is now required. Adrenaline acts through ‘receptors’ called beta receptors (seats) on the cell wall of heart muscle cells. Beta Blockers, when given occupy the seat and do not allow adrenalin to act. Thus the heart rate is not increased. As a result oxygen requirement of the heart is not increased. Thus patients on beta blockers have slower  heart rates which place them in a very safe range of the heart rate, so that even while  a patient walks, his/her heart rate does not go beyond the desired range.

Of late B-blockers have been shown to be very effective in patients with heart attack as a protective agent to the heart muscles and have become a very popular group of medicine.

Other Uses: they have also been shown to be very effective in hypertension (increased blood pressure), Anxiety, Glaucoma (a condition where pressure inside the eye increases). Migraine and Thyroid disorder.

They are also being used by cardiologists in small doses in patients with low pumping power, where they have been found to be useful only recently.

Hope you liked this blog.

This blog is written by Dr. Bimal Chajjer (Heart Care Specialist)