Drugs,For,Disorders,The,Heart, health Drugs For Disorders of The Heart
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Urokinase, alteplase and reteplase are very expensive. Streptokinase is less expensive but can cause allergy in patients with history of sore throat due to streptococal infection. High level of antibodies may render it ineffective. Urokinase (DEBUNASE) has also become cheaper and it can be used in those who are allergic to streptokinase. Each of these drugs may cause bleeding. They are not used in very high BP, pregnancy and recent surgery. If hazards of thrombolytics are high, immediate angioplasty (opening by probes) of infarct related artery is done. The maximum amount of benefit occurs if the drug is given early. Even minutes Count ('minutes mean muscle'). However, even when patients present themselves after 6 hours beneficial effects have been observed. Aspirin: A dose of 75-300 mg daily improves survival (30% reduction in death rate has been observed). Aspirin in low doses prevents stickiness and formation of aggregates of platelets. Clopidogrel (CLOPEVAS, PLAGERIL) is another powerful drug which inhibits platelet function. Diet: Food increases the blood flow in the stomach and increases the work of the heart. Therefore, the quantity of each meal should be kept small. During the first 5 days a liquid diet divided into 6 small feedings, is preferred. The solids can be gradually added after a week or so. The diet should be restricted in calories and saturated fats. Bowels: The patient may suffer from constipation due to the liquid diet, bedrest, and drugs he is taking. He should be reassured that there is any harm even if there is no bowel movement for a few days but straining may prove to be very harmful. However, it has been found that the patient is often distressed and uncomfortable without a bowel movement. He may be permitted to use rectal suppositories or may be given 30 ml of liquid paraffin. Sedation: Sedation is quite useful during the acute phase of the illness. Diazepam 5 mg, three times a day is useful.Emotional Problems: Anxiety, depression and stress can upset the patient. Reassurance (to spouse also), explanation and counselling are required. Anticoagulants: Subcutaneous heparin in a dose of 25000 units per day further prevent thrombus (clots) formation. It is used after clot dissolution with streptokinase/urokinase. It is continued for three days along with tablets of warfarin or other anti-clot drugs which are continued for subsequent treatment. This treatment is must if there is irregularity of pulse due to atrial fibrillation. Chances of bleeding are increased but close monitoring with blood tests avoids use of excessive doses. Role of Betablockers: Intravenous beta blockers (metoprolol) may be given within 12 hours to reduce rhythm disturbance and to reduce deaths which occur in first 1 to 3 days. Nitroglycerine: Intravenous NTG is very useful in left heart failure to relieve persistent chest pain due to ischaemia.Treatment of Complications: Ventricular rhythm disturbance is a serious problem and requires IV lignocaine and electrical shock (defibrillator used). Sometimes very slow pulse develops after a heart-attack. Atropine is used intravenously in this condition.Pump failure (cardiogenic shock) is due to very large infarcts and is a bad prognostic indicator and requires treatment with dopamine and fluids. Mechanical devices may also be needed. Subsequent Treatment and Drugs Those who improve are at the risk of further ischaemia. Indentifying such patients by exercise test (ECO) and echocardiography is therefore necessary. This is done at the time of discharge from hospital and 4 weeks after heart attack. Some patients may require bypass or angioplasty. The preventive measures are also started. Antiplatelet drugs (aspirin, clopidegrel), betablockers, ACE inhibitors (ramipril 2 to 5 mg once or twice a day) and reduction of raised blood fats by statins are the main measures. Ramipril prevents heart failure, improves survival, reduces hospitalisation and improves quality of life. The patients who smoke should give up smoking as the risk of death doubles in 5 years after a heart attack.
Drugs,For,Disorders,The,Heart,