The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries, which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease that narrows one or more of these arteries can block blood flow, causing chest pain (angina) or an acute coronary syndrome (see also Overview of Coronary Artery Disease).
In an acute coronary syndrome, sudden blockage in a coronary artery greatly reduces or cuts off the blood supply to an area of the heart muscle (myocardium). The lack of blood supply to any tissue is termed ischemia. If the supply is greatly reduced or cut off for more than a few minutes, heart tissue dies. A heart attack, also termed myocardial infarction (MI), is death of heart tissue due to ischemia.
There are many different reasons doctors give medications to people with coronary artery disease:
To relieve chest pain by reducing the heart's workload and widening arteries (usually nitrates)
To prevent and reverse coronary artery narrowing from atherosclerosis (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], statins, and antiplatelet medications)
To open a blocked artery (clot-dissolving medications, anticoagulants)
Often, oxygen is given through nasal prongs or a face mask. Providing more oxygen to the heart can help keep heart tissue damage to a minimum.
Medications Used to Treat Coronary Artery Disease*
Examples | Some Side Effects | Comments |
|---|---|---|
Angiotensin-converting enzyme (ACE) inhibitors | ||
Cough, usually dry and metallic Rash Rarely, a severe allergic reaction (angioedema) Possibly worsening of kidney function when people already have kidney disease or when the artery to one of the kidneys is greatly narrowed | These medications lower blood pressure and treat heart failure and prevent kidney damage in people with high blood pressure or diabetes. They also benefit people who have had heart attacks. People who have high blood pressure, heart failure, or prior heart attacks and who are treated with an ACE inhibitor live longer than people who do not take an ACE inhibitor. | |
Angiotensin II receptor blockers (ARBs) | ||
Eprosartan | Similar to ACE inhibitors, but cough is much less common | These medications have equivalent effects and benefits to those of ACE inhibitors. In people with severe high blood pressure or heart failure, these medications may be used in combination with an ACE inhibitor. |
Other medications | ||
Dizziness, headache, constipation, and nausea | This medication is used to treat people who continue to have symptoms of angina despite treatment with other drugs. | |
Blurred vision, chest discomfort, slow or fast heartbeat,headache, dizziness or fainting | This medication is used to treat symptoms of angina in some people who cannot take beta-blockers. | |
Anticoagulants | ||
Tinzaparin | Bleeding, especially when used with other medications that have a similar effect (such as aspirin and other nonsteroidal anti-inflammatory drugs) | These medications prevent blood from clotting. They are used to treat people who have unstable angina or who have had a heart attack. |
Antiplatelet medications | ||
Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants) With aspirin, stomach irritation With ticlopidine and less so with clopidogrel, a small risk of reducing the white blood cell count | These medications prevent platelets from clumping and blood clots from forming. They also reduce the risk of a heart attack. They are used to treat people who have stable or unstable angina or who have had a heart attack. Aspirin is taken as soon as a heart attack is suspected. People with an allergy to aspirin may take clopidogrel or ticlopidine as an alternative. | |
Beta-blockers | ||
Spasm of airways (bronchospasm) Abnormally slow heart rate (bradycardia) Heart failure Cold hands and feet Insomnia Fatigue Shortness of breath Depression Raynaud syndrome Vivid dreams Hallucinations Sexual dysfunction With many beta-blockers, an increase in the triglyceride level and a decrease in the level of high density lipoprotein (HDL), which is the "good" cholesterol | These medications reduce the workload of the heart and the risk of a heart attack and sudden death. They are used to treat people who have stable or unstable angina or microvascular angina or who have had a heart attack. | |
Calcium channel blockers | ||
Dizziness Fluid accumulation (edema) in the ankles Flushing Headache Heartburn Enlarged gums Abnormal heart rhythms (arrhythmias) With short-acting, but not long-acting, calcium channel blockers, possible increased risk of death due to heart attack, especially in people who have unstable angina or who have had a heart attack recently | ||
Glycoprotein IIb/IIIa inhibitors (a type of antiplatelet medication) | ||
Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants or thrombolytic medications) Reduction of the platelet count | These medications prevent platelets from clumping and blood clots from forming. They may be used to treat people who have unstable angina, particularly those who are undergoing percutaneous coronary intervention after a heart attack. | |
Nitrates | ||
Flushing Headache Temporarily fast heart rate (tachycardia) | These medications relieve angina, prevent episodes of angina, and reduce the risk of a heart attack and sudden death. (However, risk reduction is much less than that with beta-blockers.) They are used to treat people who have stable or unstable angina or microvascular angina. For these medications to remain effective over the long term, people need to go 8 to 12 hours without taking the medication each day. | |
Opioids | ||
Low blood pressure when a person stands Constipation Nausea Vomiting Confusion (especially in older adults) | In some people who have had a heart attack, these medications are used to relieve anxiety and pain if the pain persists despite use of other medications. | |
PCSK-9 inhibitors | ||
Few serious side effects | hyperlipidemia (including familial hypercholesterolemia), including people who have trouble tolerating other medications that lower cholesterol | |
Statins† | ||
Occasionally, muscle aches and pains, but rarely severe muscle pain (myositis) Rarely, liver damage, but not more commonly than in people who are not taking the medication | These medications lower cholesterol levels and help to heal damaged arteries, decreasing the chance of having a first or repeated heart attack or stroke. | |
Thrombolytic drugs | ||
Anistreplase Reteplase Streptokinase | Rarely, bleeding within the brain (intracerebral hemorrhage) or the digestive tract | These medications dissolve blood clots. They are used to treat people who have had a heart attack. |
* Doctors may use different combinations of medications depending on the type of coronary artery disease the person has. | ||
† Also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors. | ||
Nitrates
Morphine
antiplatelet medications and reduce their effectiveness and may slightly increase the risk of death.
Beta-blockers
Because decreasing the heart’s workload also helps limit tissue damage, a beta-blocker is usually given to slow the heart rate. Slowing the rate enables the heart to work less hard and reduces the area of damaged tissue.
Calcium channel blockers
Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers
Angiotensin-converting enzyme (ACE) inhibitors and (ARBs) can reduce heart enlargement and increase the chance of survival for many people. Therefore, these medications are usually given in the first few days after a heart attack and prescribed indefinitely.
Statins
Statins have long been used to help prevent coronary artery disease, but they also have short-term benefit for people with an acute coronary syndrome. Doctors give a statin to people who are not already taking one.
Antiplatelet medications
aspirin
Clot-dissolving medications
Clot-dissolving medications (thrombolytic medications) are given intravenously to open the arteries if percutaneous coronary interventions cannot be done within 90 minutes after the person arrives at the hospital.
Anticoagulants
Ranolazine and ivabradine
PCSK-9 inhibitors
hyperlipidemia, including familial hypercholesterolemia. They can be particularly useful for people who have difficulty tolerating the side effects of other medications that lower cholesterol levels.
