Drugs to Treat Myocardial Infarction

Definition

Myocardial infarction, popularly called "heart attack", occurs when heart muscle tissue dies (tissue necrosis), due to inadequate oxygen supply.

Causes

Insufficient oxygen supply to the heart causes necrosis of the heart muscle tissue, hence heart attack.

Heart attack can follow thrombosis of a large coronary branch, which in turn is an expression of atherosclerosis. Even a sudden spasm in a coronary artery can induce myocardial infarction: in this case, the cause that favors the spasm is still being studied. Other causes implicated in myocardial infarction include: heart valve deficiency (→ blood clot formation), extreme stress.

Symptoms

Myocardial infarction does not always manifest itself with the same symptoms: in fact, sometimes the symptoms appear slowly, over a few hours or days, other times suddenly, without warning.In some patients, myocardial infarction even occurs asymptomatically, while in others it leads to immediate death. In general, the most common symptoms associated with myocardial infarction are: distress, arrhythmia, heartburn, heartbeat, swollen ankles , weakness, breathing difficulties, chest pain, nausea, paleness, sweating, fainting, vomiting.

Diet and Nutrition

The information on Heart Attack - Drugs for the Treatment of Myocardial Infarction is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Heart Attack - Drugs for the Treatment of Infarction of the myocardium.

Medicines

Myocardial infarction is a full-fledged emergency, consequently the prognosis depends on the promptness with which medical help is requested; Arrhythmia is the most dangerous problem during a heart attack, which can cause the death of the victim. Emergency treatment for arrhythmia includes defibrillation (electric shocks directly connected to the heart) and cardiopulmonary resuscitation, which is essential to provide oxygen to the brain and all other anatomical sites.
It is essential to remember that every minute that passes from the onset of the heart attack without treatment can aggravate the patient's condition, up to death: the more you delay in the face of a heart attack, the more the heart tissue deteriorates, remaining without oxygen.
Patients with previous history of heart attack should recognize the signs and notify health care immediately; for these patients, it is recommended to strictly follow all measures and recommendations received from doctors, especially from the very first signs of myocardial infarction.
Now let's see which drugs can be used in therapy to treat myocardial infarction:

The following are the classes of drugs most used in therapy against myocardial infarction, and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and dosage most suitable for the patient, based on the severity of the disease, at the state of health of the patient and his response to treatment:

Antiplatelet and thrombolytic agents:

Acetylsalicylic acid (eg. Aspirin, Cardioaspirin, Aspirinetta): by reducing blood clotting, it helps to keep the blood fluid in a narrow artery. It is recommended to take 160-162.5 mg of the drug orally, once a day, starting therapy within the shortest possible time from the onset of myocardial infarction: continue with this dosage for 30 days. After this time, the dose can be changed after consulting a doctor. For prophylaxis of myocardial infarction, it is recommended to take 75-325 mg of active orally, once a day, for life.
Heparin (eg Heparin Cal Acv, Heparin Sod.Ath, Ateroclar, Trombolisin): reduces the risk of clot formation. Intravenous or subcutaneous administration is often used in the days immediately following a heart attack. Indicatively, in the context of myocardial infarction, take 5000 IU of drug once a day (bolus infusion), followed by 1000 units per hour (for continuous infusion). Dalteparin (eg Fragmin) should be taken subcutaneously, and requires a reduced frequency of administration compared to heparin (common): the drug is available in doses ranging from 2500UI / 0.2 ml, up to 18000UI / 0.72 ml. The dosage for prophylaxis from myocardial infarction is exclusively of medical competence.
Warfarin (eg Coumadin): possibly associated with acetylsalicylic acid. When used alone, it greatly increases the risk of bleeding. Begin therapy with a dose of the drug ranging from 2 to 5 mg, to be taken orally or intravenously, once a day for 1-2 days; subsequently, the dose must be fine-tuned by the physician based on the patient's general health and response to treatment. The maintenance dose is to take 2-10 mg of drug per day. The indicative duration of therapy for the treatment myocardial infarction with warfarin is about three months.
Clopidogrel (Plavix, Zyllt, Zylagren, Zopya, Iscover, Grepid, Clopidogrel Winthrop, Clopidogrel Acino): to be used for a period of 14 days, in combination with acetylsalicylic acid. Indicatively, for the treatment of myocardial infarction, take 75 mg of the drug on a fed or fasted stomach.
Alteplase (eg Actilyse): the drug is a thrombolytic indicated to dissolve blood clots (responsible for blocking the blood supply to the heart). It is recommended to take the drug as soon as possible after the onset of myocardial infarction. For the therapy of acute myocardial infarction, it is recommended to take the drug (20-50 mg) intravenously (90 minutes infusion) within 6 hours from the onset of symptoms; extend the duration from the infusion to 3 hours when the drug is administered 6-12 hours after the onset of prodrome. In this way, mortality is reduced to 30 days in patients with acute myocardial infarction. Consult your doctor.

Beta blockers: it is recommended to continue therapy for at least 2-3 years, for all patients at risk of myocardial infarction or with a previous history. Some beta blockers are able to reduce the risk of relapse. Do not stop therapy suddenly: such behavior could aggravate the condition and promote a further episode of myocardial infarction.

In cases of hypotension, uncontrolled heart failure, bradyarrhythmia and obstructive airway disease, beta-blockers are not recommended after a myocardial infarction. Instead of beta-blockers, it is recommended to take a calcium channel blocker

Acebutolol Hydrochloride (eg Prent, Sectral): the drug belongs to the class of beta blockers. It is recommended to take one 200 mg tablet of the drug, preferably before breakfast. It is possible to gradually increase the dosage up to a maximum of 400 mg per day.
Metoprolol Tartrate (eg. Seloken, Lopresor, Metoprolol AGE) for immediate treatment: start therapy for myocardial infarction with a drug dose of 5 mg, repeated three times by bolus infusion (one intravenous injection every 2- 5 minutes) If this therapeutic regimen is tolerated (heart rate and blood pressure should not drop below 60 bpm and 100 mmHg, respectively), metoprolol is administered orally at doses of 50 mg every 6 hours. for 48 hours. The first dose should be administered 15 minutes after the last 5 mg bolus infusion. After 48 hours of treatment, myocardial infarction therapy continues with the maintenance dose: 100 mg orally, twice a day.
Propanolol (eg Inderal): indicatively, take 180-240 mg per day of active ingredient, possibly divided into 3-4 doses over the course of 24 hours.
Timolol Maleate (eg Blocadren, Cusimolol, Ialutim): start therapy with a drug dose of 10 mg, to be taken by mouth, twice a day.
Verapamil (eg Isoptin, Kata): the drug belongs to the class of calcium channel blockers and iscontraindicated if left ventricular function is impaired. The drug is available in immediate-release tablets: start therapy with an active dose of 80-120 mg, to be taken three times a day; alternatively, take 40 mg of the drug, 3 times a day. The exact maintenance dose depends on the response to treatment, and may possibly be increased daily or weekly. Consult your doctor. The drug is also available in the form of slow-release tablets: in the context of myocardial infarction, start therapy with a dose of 180 mg, to be taken orally, before going to bed. Again, the maintenance dose should be established on the basis of the response to treatment.

ACE inhibitors: to be used in therapy for the prevention of relapses of myocardial infarction, even in patients in whom left ventricular function is impaired. However, not all patients with a history of myocardial infarction tolerate these drugs.

Ramipril (eg. Triatec, Unipril, Eclipse): start therapy for myocardial infarction with a dose of 2.5 mg of active ingredient, to be taken twice a day. Increase the dosage to 5 mg (to be taken twice per day) for maintenance therapy.
Lisinopril (eg Zestril, Ensor, Nosilix): the initial dose indicated for the treatment of patients affected by a heart attack is 5 mg, to be taken orally within 24 hours of the onset of symptoms. After 24 hours, proceed with an additional 5 mg dose. After another 24 hours, take 10 mg of the drug. The maintenance dose is to administer 10 mg of the drug orally, once a day. Continue with this dosage for 6 weeks The dosage can be adjusted by the doctor on the basis of the patient's blood pressure The drug may not be indicated for some patients.

Nitrates: this category of drugs is indicated to prevent myocardial infarction, especially in patients with angina pectoris.

Nitroglycerin (eg Venitrin T for infusion, Trinitrine for infusion, Natispray Spray, Triniplas patches, Trinitrina coated tablets): by temporarily dilating arterial blood vessels, it improves the blood supply to the heart, reducing the risk of a recurrence of heart attack. To be administered within 24-48 hours from the symptomatic manifestation of myocardial infarction. Start therapy by slow continuous infusion with a drug dose equal to 5 mcg / min, to be increased by another 5 mcg / min every 3-5 minutes ( up to a maximum of 20 mcg / min); subsequently, gradually increase the dose to 10-20 mcg / min, if necessary, up to a maximum of 200-400 mcg / min.

Medicines such as Isosorbide dinitrate (eg Carvasin, Dinike, Nitrosorbide) and Isosorbide mononitrate (eg Duronitrin, Elan, Ismo Diffutab, Ismo-20, Leicester, Monocinque, Monoket) can also be used in therapy for myocardial infarction. , Vasdilat), most used, however, in the treatment of angina pectoris.

Analgesics: in some cases, the heart attack is accompanied by excruciating pain in the chest; in such situations, the patient, under the supervision of a physician, can take morphine in low doses, gradually reducing the dosage before stopping the therapy. .

Morphine (eg Twice, Oramorph, Morf CL FN): the dosage of morphine varies enormously according to the perceived pain. The doses described below are purely indicative. Orally or sublingually, it is possible to take a dose of morphine ranging from 5 to 30 mg, every 3-4 hours, as needed. The drug is also available as slow-release tablets: in this case, take 10-600 mg per day, every 8-12 hours or in a single dose (once a day). Intramuscularly or subcutaneously, take 2, 5-20 mg every 3-4 hours, as needed; by intravenous injection, take 4-15 mg of active as needed (slow infusion over 4-5 minutes). For continuous infusion, take 0.8-10 mg of drug all "Now. Consult your doctor.

Drugs to treat hypercholesterolemia: when patients suffering from myocardial infarction are also affected by hypercholesterolemia, it is essential to administer drugs to reduce blood cholesterol levels: statins, fibrates and bile acid sequestrants are the most common categories of drugs. used in therapy. Here are some examples:

Fluvastatin (eg. Lescol, Lipaxan, Primesin): start therapy with a dose of drug (class: statins) ranging from 20 to 40 mg per day, once a day, before bedtime. The maintenance dose ranges from 20 to 80 mg per day.
Gemfibrozil (eg. Lopid, Genlip, Gemfibrozil DOC): the drug belongs to the class of fibrates. For the treatment of hypercholesterolemia, the normally recommended dosage is 600 mg of active, to be taken orally, twice a day, preferably 30 minutes before breakfast and dinner.
Cholestyramine (eg Questran): in general, it is recommended to start the treatment for high cholesterol with a dose of medication equal to 4 grams, to be taken orally, twice a day. For the maintenance dose, it is recommended to administer 4 grams of the drug orally, 3 times a day, before meals. However, the dose should be fine-tuned by your doctor, based on the severity of the condition and response to treatment.

For further information: see the article on drugs for the treatment of high cholesterol

When given soon after a heart attack, these drugs help improve patient survival.