Heart disease is a debilitating condition that is responsible for over 17.9 million related deaths every year.
The scientific community refers to heart conditions as cardiovascular disease, which emphasizes the susceptibility of blood vessels to all types of pathology.
However, we should note that cardiovascular disease is not one condition. It is an umbrella term that encompasses a whole range of ailments that affect the heart and blood vessels.
The best way to lower your risk of heart disease is by seeing a cardiologist who will assess the health of your cardiovascular system and decide the necessity for any treatments.
In this article, we will cover the following topics:
- The most common cardiovascular diseases (e.g., heart attacks, arrhythmias, heart failure)
- Cardiovascular meds (e.g., ACE inhibitors, beta-blockers, antiarrhythmics)
- The role of Meldonium in managing heart disease
The different types of heart disease
Myocardial infarction (i.e., heart attack)
The term “heart attack” is used by the general population to describe a medical condition known as myocardial infarction (MI).
Myocardial infarction is the leading cause of death in the United States, with around 610,000 death cases every year. In Singapore, it is the third-leading cause of death.
The most important aspect to prevent a heart attack is to identify its risk factors, which will allow you to make healthy changes before it is too late.
Why does it happen?
The pathogenesis of a heart attack is complex; however, most researchers think of it as a combination of nature and nurture factors.
The nature part includes the factors we cannot control, such as genetic predisposition, gender, and age.
The nurture part is the side of the equation we can modify, which is why they’re called modifiable risk factors.
These include smoking, uncontrolled diabetes, uncontrolled blood hypertension, high LDL (i.e., bad cholesterol) levels, obesity, and sedentary life.
In summary, in the presence of one or more of these risk factors, a fatty structure known as the atheromatous plaque will form inside your blood vessels.
More specifically, the obstruction occurs in the coronary artery, which is responsible for delivering blood to the heart muscle.
When the coronary artery gets completely obstructed, blood can’t reach some parts of the heart. As a result, the area without any blood supply will starve and die.
That, in a nutshell, is what happens during a heart attack.
Treatment of a heart attack
Once your doctor diagnoses a heart attack, he/she will focus on alleviating the obstruction in the blood vessel.
We can achieve this by:
Thrombolysis – Cardiovascular drugs used to break down the clot obstructing the blood vessel.
Catheterization – Using a tube to physically destroy the clot and restore normal blood flow to the heart muscle.
Congestive heart failure (CHF)
Congestive heart failure results from decades of poor lifestyle choices that degrade the ventricles of the heart.
The most commonly affected compartment is the left ventricle, leading to a dilated heart chamber that is unable to properly pump blood.
The risk factors for CHF include chronic blood hypertension, valve diseases (e.g., stenosis, regurgitation), and genetic conditions (e.g., Marfan syndrome).
Based on the stage of CHF, the severity of the symptoms and treatment modalities will be different.
For instance, early warning signs may include shortness of breath, persistent coughing, edema (swelling), chest pain, syncope (temporary loss of consciousness), and anorexia (loss of appetite).
At this stage, doctors can address CHF through lifestyle modifications and a heart failure medications list; however, as the disease progresses, patients may require cardiac transplantation to replace the defective heart.
Heart failure medications list includes:
- Beta-blockers
- ACE inhibitors
- Diuretics
- Mineralocorticoid receptor antagonists
Cardiac arrhythmias
Arrhythmias are common among elderly adults, resulting from irregular electrical activity in the heart muscle.
These conditions are diverse and include more than a dozen different categories, presenting with palpitations, syncope, and other general symptoms.
Meds for arrhythmias are important to mitigate the symptoms of these conditions until the implantation of pacemakers or a surgical procedure.
We will discuss more about these drugs in a moment.
Valvular heart disease
The valves in the heart get affected in two ways:
- Valvular stenosis (restricted valves that do not open properly)
- Valvular regurgitation (floppy valves that do not close properly)
The most commonly affected valves are the mitral and aortic valves, where each condition presents with unique signs and symptoms that correspond to its pathophysiology.
Common signs and symptoms of valvular diseases are:
- Heart murmur
- Cardiac arrhythmias
- Shortness of breath
- Swollen ankles
Cardiac arrest
Cardiac arrest refers to an electrical dysfunction that stops the heart from pumping blood.
There are several arrhythmias that can precipitate cardiac arrest, including ventricular fibrillation and torsade de pointes.
To rescue patients with cardiac arrest, the cardiologist shocks the heart with electrical pads in an attempt to reset the electrical current inside the muscle.
Most commonly, TV shows and movies depict the scene of rescuing a patient who had a cardiac arrest.
Cardiovascular drugs – Most common medications
Angiotensin Converting Enzyme (ACE) Inhibitors
Angiotensin Converting Enzyme (ACE) inhibitors are cardiovascular meds that inhibit the formation of angiotensin. This is a hormone responsible for constricting blood vessels, which increases blood pressure. By reducing the levels of angiotensin, ACE inhibitors facilitate the dilation of blood vessels and improve blood flow.
Patients with high blood pressure or heart failure can take ACE inhibitors as part of a more comprehensive treatment plan. Moreover, these drugs could be prescribed post-heart attack
Some common ACE inhibitors are:
- Ramipril
- Benazepril
- Captopril
Anticoagulants
Anticoagulants (i.e., blood thinners) play a crucial role in preventing heart attacks and strokes. Anticoagulants function by stopping the formation of blood clots. Some of these cardiovascular drugs work by inhibiting the production of clotting factors in the body. Others block the action of clotting factors.
It’s important to note that anticoagulants do not dissolve existing blood clots.
Examples of anticoagulants include:
- Warfarin
- Enoxaparin
- Heparin
Beta-Blockers
Beta-blockers are a class of cardiovascular meds that address a number of heart problems. The mechanism of beta-blockers involves obstructing the chemicals that stimulate the heart, including epinephrine (adrenaline). This slows down your heart rate.
Doctors may prescribe beta-blockers for a range of conditions, including:
- Heart failure
- Prevention of heart attacks
- High blood pressure
- Arrhythmia
Common examples of beta-blockers include:
- Labetalol
- Metoprolol
- Propranolol
Calcium channel blockers
Calcium Channel Blockers regulate the influx of calcium into muscle cells in both the heart and blood vessels. By controlling this process, these medications reduce the intensity of heart contractions and promote relaxation in blood vessels.
Patients with high blood pressure, coronary artery disease, and heart arrhythmias might receive calcium channel blockers.
A few examples of these medications are:
- Nifedipine
- Amlodipine
- Diltiazem
Cholesterol-lowering medications
Cholesterol-lowering medications lower LDL and raise HDL levels. This reduces the risk of plaque buildup. Some of these cardiovascular drugs decrease the risk of heart disease-related deaths.
Examples of cholesterol-lowering medications include statins (e.g., atorvastatin) and bile acid resins.
Meds for arrhythmia
These cardiovascular meds are vital in managing abnormal heart rhythms. They intervene by regulating the heart’s rhythm.
All of these drugs fall into distinct classes based on their specific actions on heart cells. Each class targets different aspects of the heart’s electrical activity to address arrhythmias.
Examples of meds for arrhythmia:
Class I
These drugs block sodium channels. Examples include:
- Procainamide
- Lidocaine
Class II
Beta-blockers slow the heart rate and reduce its response to stress hormones. Examples include:
- Propranolol
- Metoprolol
Class III
These drugs affect potassium channels, prolonging the time between heartbeats and stabilizing rhythm. Examples include:
- Amiodarone
- Dofetilide
Class IV
Calcium channel blockers slow electrical conduction in the heart. Examples include:
- Verapamil
- Diltiazem
Nitrates
Nitrates work by expanding blood vessels and improving blood flow. Individuals experiencing angina (chest pain) or heart failure might benefit from nitrates.
Common examples of nitrates include nitroglycerin and isosorbide mononitrate.
The role of meldonium in managing heart disease
Meldonium gained attention for its potential benefits in managing heart diseases. Researchers are exploring meldonium as part of combination therapy for patients with chronic heart failure in the early post-infarction period.
In a 2014 study, scientists assessed the effects of intravenous meldonium in combination therapy for patients with chronic heart failure after a heart attack. The study included 60 patients aged between 45 and 75 years. These individuals were at weeks 3-4 post-myocardial infarction and showed symptoms of heart failure.
The patients were divided into two groups:
- Group 1 (study group) received intravenous meldonium at a daily dose of 1000 mg and a standard therapy for coronary heart disease.
- Group 2 (control group) received a placebo and a standard therapy for coronary artery disease.
The results of the study revealed the following:
Clinical Improvement – Both groups experienced clinical improvement after 10-14 days of treatment.
Cardiac Parameters – Structural and functional parameters of the heart showed more notable improvements observed in the patients who received meldonium.
Takeaway message
Cardiovascular drugs are life-saving molecules that save millions of lives every single year. Meldonium has great potential in the management of numerous heart conditions.
We hope that this article helped you appreciate the diversity and impact of heart diseases as well as the underappreciated role of meldonium.
For any questions about cardiovascular meds or meldonium, please do not hesitate to share your thoughts in the comment section below.
