Medications to treat myocardial infarction
Myocardial infarction, popularly called "heart attack", occurs when heart muscle tissue dies (tissue necrosis) due to inadequate oxygen supply.
The insufficient supply of oxygen to the heart causes the necrosis of the cardiac muscle tissue, therefore the infarct.
The heart attack can result from the thrombosis of a large coronary branch, in turn an expression of atherosclerosis. Even a sudden spasm of a coronary artery can induce myocardial infarction: in this case, the cause that favors the spasm is still being studied. Among the other causes implicated in myocardial infarction, we mention: heart valve deficiency (→ formation of blood clots), extreme stress.
Myocardial infarction does not always manifest itself with the same symptoms: in fact sometimes the symptoms appear slowly, within a few hours or days, sometimes 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 anxiety, arrhythmia, heartburn, heart disease, swollen ankles, weakness, breathing difficulties, chest pain, nausea, pallor, sweating, fainting, vomiting.
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Information on heart attacks - 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 Infarct - Medications for the treatment of myocardial infarction.
Myocardial infarction is an emergency in all respects, therefore the prognosis depends on the promptness with which medical aid is requested; arrhythmia is the most dangerous problem during a heart attack, which can cause the death of the victim. The emergency treatment for arrhythmia includes defibrillation (electrical discharges directly connected to the heart) and cardiopulmonary resuscitation, which is essential to supply oxygen to the brain and to all other anatomical sites.
It is essential to remember that every minute that elapses from the onset of a heart attack without treatment can aggravate the patient's condition, until death: the longer he lingers in front of a heart attack, the more the heart tissue deteriorates, remaining without oxygen.
Patients with a history of heart attack should recognize the signs and immediately notify health care; for these patients, it is recommended to scrupulously follow all the measures and recommendations received from doctors, especially from the earliest signs of myocardial infarction.
Now let's see which drugs can be used in therapy to treat myocardial infarction:
Platelet and thrombolytic anti-aggregation agents :
- Acetylsalicylic acid (eg. Aspirin, Cardioaspirin, Aspirinetta): by reducing blood coagulation, it helps to keep the blood fluid in a restricted artery. It is recommended to take 160-162.5 mg of oral drug once a day, starting the therapy as soon as possible after the occurrence of myocardial infarction: continue with this dosage for 30 days. After this period of time it is possible to change the dose, after consulting a doctor. For the prophylaxis of myocardial infarction, it is recommended to take 75-325 mg of orally active, 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 2500IU / 0.2ml, up to 18000IU / 0.72 ml. The dosage for prophylaxis from myocardial infarction is exclusively medical.
- Warfarin (eg. Coumadin): possibly associated with acetylsalicylic acid. When used in monoterpy, the risk of bleeding increases enormously. Start the therapy with a dose of drug varying from 2 to 5 mg, to be taken orally or intravenously, once a day for 1-2 days; subsequently, the dose must be perfected by the doctor based on the patient's general state of health and his response to treatment. The maintenance dose involves taking 2-10 mg of the drug a day. The approximate duration of therapy for the treatment of 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 drug on a full or fasting stomach.
- Alteplase (eg. Actilyse): the drug is a thrombolytic indicated to dissolve blood clots (responsible for obstructing the blood supply to the heart). It is recommended to take the drug as soon as possible after the manifestation of myocardial infarction. For the treatment of acute myocardial infarction, it is recommended to take the drug (20-50 mg) intravenously (90-minute infusion) within 6 hours of the onset of symptoms; prolong the duration from infusion to 3 hours when the drug is administered 6-12 hours after the prodromal manifestation. In this way, mortality is reduced to 30 days in subjects with acute myocardial infarction. Consult your doctor.
Beta-blockers : it is recommended to continue the therapy for at least 2-3 years, for all patients at risk of myocardial infarction or previous history. Some beta-blockers are able to reduce the risk of relapses. Do not interrupt therapy suddenly: similar behavior could aggravate the conditions and promote a further episode of myocardial infarction.
In the event of hypotension, uncontrolled heart failure, bradyarrhythmia and obstructive airway diseases, beta-blockers are not recommended after a myocardial infarction. In place of beta-blockers, it is recommended to take a calcium channel blocker
- Acebutolol Hydrochloride (eg Prent, Sectral): the drug belongs to the beta blocker class. It is recommended to take a 200 mg tablet of medication, 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: starting therapy for myocardial infarction with a drug dose of 5 mg, repeated three times by bolus infusion (an intravenous injection every 2- 5 minutes). If this therapeutic scheme is tolerated (heart rate and arterial pressure must not fall 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, possibly divided into 3-4 doses during 24 hours.
- Timolol Maleato (eg. Blocadren, Cusimolol, Ialutim): start therapy with a dose of drug equal to 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 is contraindicated if left ventricular function is compromised. The drug is available in immediate release tablets: start the 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 the cure, and can 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. Also in this case, the maintenance dose should be established based on the response to the cure.
ACE inhibitors : to be used in therapy for the prevention of relapses of myocardial infarction, even in patients whose left ventricular function is compromised. 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 a day) for maintenance therapy.
- Lisinopril (eg. Zestril, Ensor, Nosilix): the initial dose indicated for the treatment of patients suffering from 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 involves administering 10 mg of oral medication once a day. Continue with this dosage for 6 weeks. The dosage can be modulated by the doctor based on the patient's blood pressure. The drug may also 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, Trinitrina for infusion, Natispray Spray, Triniplas plasters, Trinitrina coated tablets): by temporarily dilating the arterial blood vessels, it improves the blood supply to the heart, reducing the risk of heart attack. To be administered within 24-48 hours from the symptomatic manifestation of myocardial infarction. Start the therapy by slow continuous infusion with a dose of drug 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.
In therapy for myocardial infarction, drugs 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., Vasdilat), most used, however, in the treatment for angina pectoris.
Analgesics : in some cases, the heart attack is accompanied by a stabbing pain in the chest; in similar situations, the patient, under the supervision of a doctor, can take morphine at low doses, gradually reducing the dosage before ending the therapy.
- Morphine (eg Twice, Oramorph, Morf CL FN): morphine intake dosage varies enormously based on 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 a 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; for intravenous injection, take 4-15 mg of active as needed (slow infusion in 4-5 minutes). For continuous infusion, take 0.8-10 mg of the drug per hour. Consult your doctor.
Drugs to treat hypercholesterolemia : when patients suffering a myocardial infarction are also suffering from hypercholesterolemia, it is essential to administer drugs to reduce cholesterol levels in the blood: statins, fibrates and bile acid sequestrants are the most common drug categories used in therapy. Here are some examples:
- Fluvastatin (eg Lescol, Lipaxan, Primesin): start therapy with a dose of the drug (class: statins) ranging from 20 to 40 mg a day, once a day, before going to bed. The maintenance dose varies from 20 to 80 mg a day.
- Gemfibrozil (eg Lopid, Genlip, Gemfibrozil DOC): the drug belongs to the class of fibrates. For the treatment of hypercholesterolemia, the normally recommended posology 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 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. The dose must however be perfected by your doctor, based on the severity of the condition and the response to treatment.
For further information: see the article on drugs for the treatment of high cholesterol
When given immediately after a heart attack, these drugs help improve patient survival.