Patient education: Medicines after a heart attack (The Basics)

Why are medicines needed after a heart attack? — After a heart attack, medicines can help improve your health and lower your risk of having another heart attack.

Your doctor will prescribe you medicines to:

●Help prevent more heart attacks and help you live longer

●Prevent chest pain (also called "angina")

Which medicines might I need? — Many people who have had a heart attack take 3 medicines or more. Each of them does something different to help you. Take them exactly how your doctor tells you to (table 1).

Your doctor might give you medicines that can:

●Prevent blood clots

●Lower cholesterol (medicines called "statins")

●Lower blood pressure

●Prevent another heart attack (medicines called "beta blockers")

●Help with chest pain

You should also get a flu vaccine every year.

Medicines to prevent blood clots — Most heart attacks happen because a blood clot forms in an artery in the heart. This stops blood from reaching the heart muscle. Medicines that can lower the chances of this happening include:

●Aspirin – This is the most commonly used medicine to prevent blood clots.

●Antiplatelet medicines – These are sometimes given along with aspirin. Examples include clopidogrel (brand name: Plavix), ticagrelor (brand name: Brilinta), and prasugrel (brand name: Effient).

Do not stop taking these without talking to your heart doctor, even if another doctor or nurse tells you to stop.

If you run out of this medicine, call your doctor. They will tell you if you need to get more or if you no longer need it.

Statins — Statins are medicines used to treat high cholesterol. They work on fatty clumps in the arteries called "plaques." Most heart attacks happen when plaques in the heart break open. When that happens, blood clots form around these plaques. The blood clot blocks blood flow to the heart muscle.

Statins can:

●Lower the chance that new plaques will form

●Lower the chance that existing plaques will grow or break open

●Prevent blood clots from forming around the plaques if they do break open (figure 1)

●Help prevent stroke

Examples of statins include atorvastatin (brand name: Lipitor), lovastatin (brand names: Mevacor, Altoprev), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor), pitavastatin (brand name: Livalo), and simvastatin (brand name: Zocor).

Medicines to lower blood pressure — Having high blood pressure:

●Damages the walls of the blood vessels

●Makes it more likely that plaques will form or break open

Medicines that lower blood pressure help prevent this from happening. They include:

●Diuretics ("water pills") – Examples include chlorthalidone and hydrochlorothiazide ("HCTZ").

●Medicines to lower blood pressure – Examples of blood pressure medicines used after a heart attack include enalapril, captopril, lisinopril, candesartan (brand name: Atacand), and valsartan (brand name: Diovan).

Medicines called "beta blockers" can also lower blood pressure and lower the risk of a future heart attack. When you first start taking a beta blocker, it might make you feel tired. But once your body gets used to the medicine, it can really help. If your doctor prescribes a beta blocker, give your body some time to get used to it. Examples of beta blockers include carvedilol (brand name: Coreg) and metoprolol succinate (brand name: Toprol-XL).

Some people need more than 1 medicine to lower their blood pressure. You might get a pill that combines 2 different medicines in a single pill.

Medicines to help with chest pain — Blocked arteries in the heart can cause chest pain. This is called "angina." Many medicines can help with angina.

Medicines that prevent angina symptoms include:

●Beta blockers

●Calcium channel blockers

●Nitrates – These come as either a pill or a patch that you put on your skin.

There is also a type of nitrate that you can take when chest pain starts. It is called "nitroglycerin" or "glyceryl trinitrate." It comes as a pill that you put under your tongue, or as a spray that you use on or under your tongue.

Are there any medicines I should avoid? — Certain medicines can change how your heart medicines work, or make them work less well. Your doctor or nurse will tell you if you need to avoid certain prescription or over-the-counter medicines, herbs, or supplements. If you have questions about whether it is safe to take a medicine, ask your doctor, nurse, or pharmacist.

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

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