Most common heart-related conditions
- provided by America's leading cardiologists

Medications

Approximately 10 million people suffer from heart failure a year, but this condition, which occurs when the heart loses the ability to pump blood efficiently, can be caused by a number of different conditions. Select a program below to learn more about the many causes of and treatments for heart failure.

• How is Angina Treated?
• How Safe are Cholesterol Medications?
• What is the Prophylaxis for Endocarditis?
• What Medicines Do I Take After a Stent?
• Erectile Dysfunction & Hypertension

How is Angina Treated?
If you experience chest pain or discomfort, you may be suffering from angina. Tune in to find out more about this common form of heart disease.

Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University, Columbus, Ohio
Richard O. Russell, MD

Webcast Transcript:

ANNOUNCER: Angina pectoris, often referred to as angina, is the most common type of heart disease. It's caused when the heart muscle doesn't get enough blood, and it can be treated in a variety of ways.

RICHARD P. LEWIS, MD: The bedrock treatment of angina is drugs. And the main drugs that we use are beta blockers, which are adrenalin-blocking drugs that slow the heart rate and prevent the adverse effects of adrenalin on precipitating heart attacks and abnormal heart rhythms; statin drugs, which lower the blood cholesterol, which have been shown to reduce the incidence of heart attacks and make people live longer and stabilize the heart artery disease that's causing the angina; nitroglycerin for when a person actually has an angina attack; often we will use aspirin and perhaps other blood clot inhibiting drugs as well, depending on the situation; and then we may add high blood pressure medicines if the person also has high blood pressure, which can make his angina more likely to happen.

ANNOUNCER: After diagnosis, medication is the first step in treating angina. But there are other methods doctors can use, including enhanced external counterpulsation or EECP.

RICHARD O. RUSSELL, MD: Counterpulsation is the treatment where cuffs are put on the legs, like stockings with various compartments in the stockings, and over a period of about an hour—and there is a prescribed five days a week, seven weeks of therapyfor an hour or so—these cuffs are pumped full of air, relaxed, pumped full of air and relaxed. And that is pulsation. It doesn't try to keep up with the heart rate. They are just pumped several times a minute. We think it helps to increase the collateral or detour blood flow in the arteries of the heart themselves to deliver more blood to the heart. And it's been astoundingly successful. It doesn't have any complications really. The patients come each day for five days a week, and this counterpulsation seems to improve the circulation to the heart and actually improves angina. It decreases the frequency of angina pectoris.

Lifestyle change will also play an important role after you've been diagnosed with angina.

RICHARD P. LEWIS, MD: If a person develops angina, they must stop smoking first. Smoking accelerates the process of heart artery disease and makes a heart attack and sudden death more likely to happen. In most cases, you need to lose some weight and change your diet. Getting regular exercise: It turns out that if you exercise regularly, not only does it help your blood lipids, but it makes your body less likely to have a heart attack. It lowers the level of inflammation in the heart arteries, which is what makes the disease progress. So exercise is very important.

I tell people that have angina to listen to their body. It's amazing. "Some days," people say, "I can do anything I want to. Other days I just go up a flight of stairs and I get my angina." I tell people that if you're feeling well when you're doing it, it's okay. Your heart will let you know.

How Safe are Cholesterol Medications?
It's important for those with high cholesterol to learn about the medications they may take to control it. Find out what the experts think about the most commonly used drugs.

Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine, Akron General Medical Center, Akron, Ohio
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia

Webcast Transcript:

ANNOUNCER: For those with high cholesterol, a common concern is about the safety of the medications used to lower it.

SUZANNE HUGHES, MSN, RN: The medications that lower cholesterol are in general very, very safe. The largest group of drugs that most people have heard the most about are called the statins, and the statins have been on the market now since September of 1987, and they overall have a great safety record.

Now, these drugs are metabolized by the liver, and so it's necessary for a person taking these medications to have regular blood tests, not only to measure how effective the medications are in optimizing the cholesterol profile, but also to make sure that there aren't any adverse effects on the liver.

ANNOUNCER: Besides the possibility of affecting the liver, there are other considerations to keep in mind.

SPENCER B. KING, III, MD: There are some other potentially dangerous things like muscle aches that may lead to complications, kind of a flu-like feeling that can develop. But in general, the cholesterol-lowering drugs are very safe.

Sometimes we worry about any side effect of a drug, but in doing that we must also look at what the drug is doing in a positive way, and the cholesterol-modifying drugs are one of our most important breakthroughs in medicine. So no one should avoid the use of these drugs if they're indicated simply because of fear of some of these side effects.

ANNOUNCER: In addition to statins, there are other medications that can lower cholesterol.

SUZANNE HUGHES, MSN, RN: Another one is fibrates that generally operate not to lower the LDL, like the statins do, but to normalize the triglyceride and the HDL cholesterol. These are also very safe, although when used in combination with a statin do require a little more careful followup.

And another class of medications is the niacin group. And there's a prescription medicine that's niacin that actually can very nicely raise the HDL cholesterol and lower triglycerides.

And then the last main class is the bile acid sequestrants, a group of medicines that actually can lower the LDL cholesterol, and they are not processed through the liver. They just act entirely on the gastrointestinal system.

NANETTE KASS-WENGER, MD There's a new medicine on the scene called ezetimibe, which prevents the absorption of cholesterol, and this has been added to a statin to provide further cholesterol lowering. ANNOUNCER: With all the information available, patients with high cholestrol have many treatment options to consider with their physican.

NANETTE KASS-WENGER, MD: The most important thing is the benefit. No drug is absolutely safe, just as crossing the street is not absolutely safe. And when you decide to take a drug, or when I recommend that you take a drug, it really is because the benefits of this drug far, far, far, far outweigh any potential adverse effects.

What is the Prophylaxis for Endocarditis?
Learn what factors may dictate whether you need treatment to prevent an infection in your heart.

Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College of Medicine, Lexington, Kentucky

Webcast Transcript:

ANNOUNCER: For those with structural heart disease, and important question is: What is the prophylaxis for endocarditis?

JACQUELINE NOONAN, MD: Well, the prophylaxis for endocarditis is medicine that you take when you are undergoing a procedure that would put you at risk for what we call bacteremia. That is, something happening where there are germs that are likely to get into your blood. And we know now that, if you go into the dentist, and he scrapes all your tartar away or if he pulls your teeth that, if you checked somebody's blood right afterwards, they will find that there are germs in your blood, some bacteria, which usually the body clears. But if you have any kind of structural heart disease, unfortunately, those bacteria, as they're in your bloodstream, might land on this area in your heart and set up housekeeping there, and you could get an infection on your heart, which is called endocarditis.

So it's recommended when you go to the dentist, when you get dental work done, most kinds of dental work, not everything, it's also recommended when you have procedures where they are going to be intubating you, where there might be some risk, where they're going to have urologic procedures.

You don't want to put a lot of people at risk who have very little chance of getting endocarditis from what they're doing and have the chance of perhaps having them have a allergic reaction to the drug, to perhaps having a drug then become resistant when they really need it. So I think most physicians would feel obliged to recommend prophylaxis for somebody with structural heart disease when they undergo invasive procedures of any kind.

What Medicines Do I Take After a Stent?
After a stent is placed in an artery, there is a chance that a blood clot may develop. To help prevent clots, antiplatelet drugs are often prescribed after the stenting procedure.

Participants:
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations with the Experts American College of Cardiology

Webcast Transcript:

ANNOUNCER: A common question asked by people who have stents is why they need to continue taking drugs like Aspirin, Plavix or Coumadin.

SPENCER B. KING, III, MD: After stenting, the blood platelets—these are little particles within the blood that help us stop bleeding, if we cut, they collect and form a clot—those platelets can be detrimental after you have a stent placed. They can actually build up on the stent and may cause a clot to form there.

ADOLPH M. HUTTER, JR., MD: We need to use some drugs that prevent blood clots from forming in the stent or from restenosis. And the most effective drugs have been shown to be the antiplatelet drugs: That's Aspirin or clopidogrel, called Plavix. These are the anti-platelet drugs. They work very well.

Coumadin, which is a blood thinner against clots formed by thrombin doesn't work very well for stents. So you need to be on aspirin and Plavix, but you don't need to be on Coumadin just for a stent. You might need Coumadin for another reason, but you don't need it just because you have a stent.

SPENCER B. KING, III, MD: Coumadin is an anti-clotting drug that people know about, but it is not routinely used after stenting. It has different uses, in atrial fibrillation and in preventing clots in the legs and all sorts of things. But when stents are used, it's the combination of aspirin and the clopidogrel that is critical.

ANNOUNCER: Determining which drug a patient should use depends on the type of stent they have.

ADOLPH M. HUTTER, JR., MD: If you have a bare metal stent, then you should be on aspirin 325 mg/day, and Plavix 75 mg/day, for a month. If you have a drug-eluting stent, we know that those events can occur many, many months after a month, and so most people recommend that you be on aspirin 325 mg/day, and Plavix 75 mg/day indefinitely, at least for six months.

Erectile Dysfunction & Hypertension
Hypertensive patients worry about which medications are safe to take, including erectile dysfunction (ED) drugs. Find out how ED medication affects hypertension.

Participants:
Franz H. Messerli, MD
Clinical Professor of Medicine; Tulane University School of Medicine

Webcast Transcript:

ANNOUNCER: Many patients with hypertension want to know if it's safe to take drugs that treat erectile dysfunction.

FRANZ MESSERLI, MD: Now, one has to consider in this context that basically from a physiologic point of view, sex has to be considered a form of exercise. It increases heart rate. It increases cardiac output. So it puts a burden on the heart.

But in general, this burden is very well-tolerated by the hypertensive patients, because we do let our hypertensive patients exercise. They should engage into regular exercise. We told them to do so. So there's nothing wrong with them having sex.

Now, when you look specifically at the drugs that improve erectile function, such as Viagra, such as Cialis, such as Levitra, if anything, they actually lower blood pressure a little bit. And if anything, they have a positive effect on the coronary flow in the heart. So to my way of thinking these drugs are rarely contraindicated in hypertensive patients. And even if—and I see a lot of complicated hypertensive patients who are on triple and quadruple and quintuple therapy—even in these patients, I have no hesitation to prescribe one of these drugs.

ANNOUNCER: Although it is generally acceptable to take erectile dysfunction medication if you have hypertension, there is one major caution: If you are taking nitrates for coronary disease or angina, erectile dysfunction medication should be avoided. This combination of drugs can cause dangerous dips in blood pressure.