Following a heart attack, a person may be prescribed various medications to manage risks, improve heart function, and prevent further cardiac events. These could include:
After a heart attack, doctors often prescribe a combination of medications to help manage the risk of future complications. This article will discuss some common medications used in heart care and their potential side effects.
Angiotensin-Converting Enzyme (ACE) Inhibitors
ACE inhibitors, such as benazepril, moexipril, ramipril, trandolapril, captopril, perindopril, quinapril, enalapril, fosinopril, and lisinopril, help prevent high blood pressure and future heart attacks. They work by blocking the conversion of angiotensin I to angiotensin II, which in turn reduces the narrowing of blood vessels and the strain on the heart.
However, ACE inhibitors can cause side effects like a dry cough, dizziness, hypotension, elevated levels of urea, nitrogen, and creatine in the blood, hyperkalemia, fainting, angioedema (swelling of the face, lips, and upper airways), and low blood pressure.
Angiotensin Receptor Blockers (ARBs)
ARBs, such as azilsartan, telmisartan, valsartan, candesartan, eprosartan, olmesartan, irbesartan, and losartan, prevent blood pressure from rising by preventing angiotensin II from affecting the blood vessels and heart. ARBs come in tablet form and can cause a cough, fluid buildup anywhere in the body, hypotension, and hyperkalemia.
Statins
Statins, including simvastatin, atorvastatin, pitavastatin, pravastatin, rosuvastatin, fluvastatin, and lovastatin, help reduce the levels of low-density lipoprotein (LDL) cholesterol in the blood. These medications are often prescribed to reduce the risk of heart disease and stroke.
However, statins can cause side effects such as statin-associated muscle symptoms, ranging from mild muscle aches, pains, and cramps to severe muscle damage in rare cases.
Anticoagulants
After a heart attack, doctors usually recommend anticoagulants to prevent blood clots from forming. Common anticoagulants include warfarin and newer oral anticoagulants like rivaroxaban.
For warfarin, the most frequent side effect is bleeding, which can range from minor bruising to severe and potentially fatal bleeding events anywhere in the body. Other side effects include nausea, diarrhea, rash, hair loss, and rare skin complications like warfarin-induced skin necrosis and purple toes syndrome. Long-term use may also increase the risk of osteoporosis.
For rivaroxaban and other newer oral anticoagulants (NOACs), bleeding is also the most serious and common side effect, including internal bleeding. Other reported issues include the risk of spinal hematoma and allergic reactions like anaphylaxis. There may be concerns about liver toxicity, though more studies are needed. These medications require caution when combined with certain other drugs (like amiodarone) that can increase bleeding risk. Unlike warfarin, NOACs typically do not require routine blood monitoring.
Beta-blockers
Beta-blockers, such as bisoprolol, acebutolol, atenolol, nadolol, propranolol, sotalol, betaxolol, bisoprolol/hydrochlorothiazide, and metoprolol, work to slow the heart rate and decrease the force of contraction of the heart. They can come in tablet, injection, or IV forms and can cause low blood pressure, slow heart rate, extreme tiredness, dizziness, nausea, constipation, and erectile dysfunction.
It's important to note that everyone's body reacts differently to medications, and the right combination will be different for everyone. Patients should always discuss any symptoms or potential side effects with their healthcare team. Additionally, patients should avoid medications or foods that may alter anticoagulant effects without medical advice.
[1] Mayo Clinic. (2021). Warfarin side effects. Retrieved from https://www.mayoclinic.org/drugs-supplements/warfarin-oral-route/side-effects/drg-20066245
[2] Mayo Clinic. (2021). Rivaroxaban side effects. Retrieved from https://www.mayoclinic.org/drugs-supplements/rivaroxaban-oral-route/side-effects/drg-20375289
[3] National Heart, Lung, and Blood Institute. (2021). Warfarin. Retrieved from https://www.nhlbi.nih.gov/health-topics/warfarin
[4] National Heart, Lung, and Blood Institute. (2021). Rivaroxaban. Retrieved from https://www.nhlbi.nih.gov/health-topics/rivaroxaban
[5] U.S. Food and Drug Administration. (2021). Rivaroxaban. Retrieved from https://www.fda.gov/drugs/drugs-information/rivaroxaban
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