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Family Health Magazine
PHARMACY CARE

After Your Heart Attack
Changes and medications to prevent a repeat

As you leave the hospital after surviving your heart attack, you’re a little overwhelmed. You’ve been poked, prodded, tested and given lots of information about adopting a new, healthier lifestyle. Before you can return home and begin the next phase of your recovery, you have one last stop to make - at your local pharmacy.

There, you will pick up the medications prescribed before your discharge from the hospital. You’ve probably never before had so many different prescriptions at one time. Together with the changes you will make to your lifestyle, these medications will help your body heal and prevent another heart attack. But what are they and what do they do?

First, you should understand what causes a heart attack. Also known as a myocarcial infarcation, a heart attack occurs when the blood supply to the heart is severely reduced or stopped. Over time, the walls of the arteries which supply blood to the heart (coronary arteries) can become thickened with plaque made of cholesterol and fats. This is called atherosclerosis or, more simply, hardening of the arteries.

The blockage narrows the arteries and reduces blood flow to the heart. Sometimes the plaque ruptures, forming a blood clot that completely blocks the already narrowed artery. This is called a coronary thrombosis. In other cases, an artery of the heart goes into spasm. This causes the artery to narrow decreasing blood flow to a part of the heart muscle. When blood flow to the heart is reduced, heart tissue does not get enough oxygen (ischemia).

Whether caused by a clot or an artery spasm, not enough blood and oxygen are supplied to the heart. When this occurs for prolonged periods, the heart muscle is damaged or dies, resulting in a heart attack. The seriousness of a heart attack and the chances of survival depend on three things: how much tissue is damaged, how much oxygen is lacking, and the region of the heart involved.

Recovery from a heart attack requires both changes to your lifestyle and prescription medication. The first stages of treating a heart attack attempt to restore blood flow to the heart, saving heart tissue. During recovery, drug treatment treats the affected areas of the heart and decreases certain risk factors to prevent another heart attack. (See table for a list of commonly described drugs and how they work.)

As an important member of the health care team, your pharmacist helps to keep you well-informed about your medication. The pharmacist can tell you about more common side effects that may occur. Remember that it is not possible to predict which specific side effects you may experience. If you notice side effects developing or if they change in intensity, tell your doctor or pharmacist as soon as possible.

Make sure your pharmacist is aware of any over-the-counter products you may be taking, as well as any other prescriptions as they may conflict with your new medications. Counselling is available to help you with your complex routine of medications. If you find it challenging to manage so many medications, or if you can’t always remember whether or not you took your last dose, ask your pharmacist about blister packing of medication and dosettes.

By sticking to medical treatments and making healthy lifestyle changes, you can reduce your risk of another heart attack.

Controllable Risk Factors

The major risk factors for heart attack are: being a male, having diabetes, smoking, being overweight, high cholesterol, a sedentary or inactive lifestyle and having high blood pressure. Those you can control or lessen to prevent a first or subsequent heart attack are:

High blood pressure (hypertension)

Systolic pressure is the maximum pressure in the arteries when the heart contracts (beats). This is the first number in a blood pressure reading. Diastolic pressure is the minimum pressure in the arteries when the heart relaxes and is at rest. This is the second number.

Blood pressure is considered to be elevated when it is greater than 140/90 (or greater than 130/85 for people with diabetes, heart failure or kidney problems). Regular and accurate monitoring of blood pressure is important to diagnose, prevent and treat hypertension. High blood pressure can damage blood vessels and provoke a heart attack. Taking your blood pressure medication every day helps to keep your blood pressure low and prevents further heart damage. Don’t skip a dose even if you feel fine or if your blood pressure reading is normal.

Remember, medications do not cure high blood pressure; they merely keep it under control.

Reduce the amount of salt (sodium) you eat and alcohol you drink. Salt can cause the body to retain more water, which increases blood pressure and increases the heart’s workload.

High cholesterol levels

LDL (low density lipoprotein) cholesterol is the so-called bad kind of cholesterol. This cholesterol is the type that contributes to the process of hardening and narrowing of the arteries. The lower the level of LDL cholesterol, the better. HDL (high density lipoprotein) cholesterol is a good form of cholesterol. HDLs carry cholesterol away from the arteries towards the liver for elimination. The higher the HDL cholesterol level, the better. A complete blood cholesterol test, also called a lipid panel, measures total cholesterol as well as LDL, HDL and triglycerides, a special kind of fat.

Medication is aimed at reducing the harmful LDL cholesterol and increasing the helpful HDL cholesterol. In addition, your diet should emphasize healthy foods, especially whole grains, fruits and vegetables, a variety of meat, fish and poultry, legumes and lower fat milk and milk products. Also limit foods high in fat and cholesterol. Your doctor may recommend you see a dietitian who will work with you to make any needed changes to your diet.

Diabetes

Diabetes is associated with higher levels of LDL cholesterol and triglycerides, as well as lower levels of HDL cholesterol. Diabetes is therefore considered a risk factor for heart disease and atherosclerosis. Those with diabetes must learn to manage it properly.

Inactive lifestyle

Regular physical exercise will reduce triglycerides and LDL cholesterol, and increase HDL cholesterol. It will also decrease blood pressure, improve the flow of blood to the heart and improve the body’s ability to dissolve blood clots.

Smoking

Nicotine contributes to the formation of fatty plaques. Smoking causes the blood vessels to constrict, thus causing blood pressure to rise. Talk with your pharmacist or doctor about the products and programs available to help you stop smoking.

Extra Weight

Being overweight causes your heart to work harder. Regular physical exercise and a healthy diet can help with weight control. Please discuss weight loss strategies with your doctor and/or dietitian.

The long-term outcome for both length and quality of life after a heart attack depends on its seriousness and the preventive measures taken afterward. Family members can be very helpful in providing the much needed care and support for lifestyle and dietary changes. The success of any prevention program after a heart attack is directly related to being actively involved in your own health care.

Pharmacists, as an essential part of the health care team, are available to answer any questions and assist you in making a complete recovery. Feel free to call or drop by to discuss your medications or any other health concerns that you may have. Take control of your health and make use of your available resources.

Drugs Commonly Used in the Prevention and Treatment of Heart Attack