Patient education: Medicines after a heart attack (The Basics)

What do the medicines prescribed after a heart attack do? — If you have a heart attack, the medicines your doctor prescribes afterward can:

●Help prevent other heart attacks and help you live longer

●Make you feel better by preventing chest pain (also called "angina")

Which medicines might I need? — Many people who have had a heart attack take 3 medicines or more. That might seem like a lot, but each of them does something different to help you. It's important that you take them exactly how your doctor prescribes (table 1).

Below is a list of the most common types of medicine given to people after they've had a heart attack. (People who have had a heart attack should also have a flu vaccine every year.)

●Medicines to prevent blood clots

●Medicines called "statins"

●Medicines to lower blood pressure

●Medicine to prevent another heart attack (called "beta blockers")

●Medicines to reduce the number of episodes of chest pain

Medicines to prevent blood clots — If a clot forms in an artery in the heart, it can keep blood from reaching parts of the heart muscle. This is what causes most heart attacks. There are medicines that can reduce the chances of this happening. The most commonly used medicine to prevent blood clots is aspirin. But other medicines to prevent clots can be used in addition to aspirin. These are also called "anti-platelet" medicines. Examples of anti-platelet medicines include clopidogrel (brand name: Plavix), ticagrelor (brand name: Brilinta), and prasugrel (brand name: Effient). Talk with your heart doctor before stopping this medicine, even if told to do so by another healthcare provider.

Statins — Most heart attacks happen when fatty clumps (called "plaques") in the arteries that bring blood to the heart break open. When that happens, blood clots form around these plaques and block off the flow of blood to the heart muscle. Statins reduce the chances that new plaques will form, or that existing plaques will grow or break open. They might also prevent blood clots from forming around the plaques if they do break open (figure 1). Examples of statins include atorvastatin (brand name: Lipitor), lovastatin (brand names: Mevacor, Altoprev), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor), pitavastatin (brand name: Livalo), and simvastatin (brand name: Zocor). These medicines can also help prevent strokes.

Medicines to lower blood pressure — High blood pressure damages the walls of the blood vessels and makes it more likely that plaques will form or break open. Medicines that lower blood pressure help prevent this from happening. There are lots of different medicines to lower blood pressure. Some people need more than one medicine to get their blood pressure low enough. In some cases, doctors prescribe a combination pill that has 2 different medicines in a single pill. The main blood pressure medicines that doctors prescribe include:

●Diuretics (sometimes called "water pills") – Some examples of diuretics for blood pressure include chlorthalidone and hydrochlorothiazide (also known as HCTZ).

●ACE inhibitors and ARBs – Angiotensin-converting enzyme inhibitors (called "ACE inhibitors") and angiotensin receptor blockers (called "ARBs") are often grouped together, because they work in similar ways. Some examples of ACE inhibitors include enalapril, captopril, and lisinopril. Some examples of ARBs include candesartan (brand name: Atacand) and valsartan (brand name: Diovan).

●Calcium channel blockers – These medicines also help prevent you from having chest pain from blocked blood vessels (called "angina").Some examples of calcium channel blockers include amlodipine (brand name: Norvasc), felodipine (brand name: Plendil), nifedipine XR (brand name: Procardia XL) and diltiazem (brand name: Cardizem).

Medicines to prevent another heart attack — Beta blockers slow the heart down and can lower blood pressure. They help reduce the amount of work the heart has to do. Studies show that people who take a beta blocker after a heart attack are less likely to have another heart attack and die than people who don't take a beta blocker.

When people first start taking beta blockers, they sometimes feel tired until their body gets used to the medicine. But once the body gets used to beta blockers, the medicines can really help. If your doctor prescribes a beta blocker, give it a little time for your body to get used to it.

Some examples of beta blockers include atenolol (brand name: Tenormin) and metoprolol (brand names: Lopressor, Toprol-XL).

Medicines to reduce episodes of chest pain — There are lots of different medicines to reduce the chest pain and discomfort caused by blocked heart arteries (called "angina"). Beta blockers and calcium channel blockers (mentioned above) help prevent symptoms from happening in the first place. Another type of medicine, called "nitrates," can also prevent symptoms if you take them on a regular basis or use a nitrate patch. Plus, there's a type of nitrate (called "nitroglycerin" or "glyceryl trinitrate") that works very quickly and can relieve symptoms when they start. This medicine comes in a pill that you put under your tongue or a spray you use on or under your tongue.

Are there any medicines I should avoid? — Some medicines can "interact" with other medicines. Taking certain medicines can change how your heart medicines work or make them work less well. Your doctor or nurse will talk to you about whether you need to avoid certain prescription or over-the-counter medicines, herbs, or supplements. If you have any questions about whether it is safe to take a medicine, ask your doctor, nurse, or pharmacist.

For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

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