To date, the abundance and availability of cardiac drugs have not significantly improved the statistics regarding diseases of the cardiovascular system. Pathologies of the heart are steadily appearing among more and more young people and continue to be the leading cause of death of otherwise healthy individuals throughout the world.
Causes of pain in the heart
The heart and vascular system compose a complex mechanism with a continuous cycle of action and which has close interrelation with all other systems of the body. Doctors, when selecting a pill for a patient with pain in the heart, primarily look for the cause of these pains.
Generally, these pains can arise because of:
- Various forms of ischemic heart disease (IHD), including angina pectoris of all types and physiological classes;
- Myocardial infarction (a severe form of IHD);
- Inflammatory processes in the layers of the heart (e.g., pericarditis, myocarditis, endocarditis);
- Pathology of metabolism in the myocardium due to a deficiency of proteins, microelements, or vitamins; diseases of the endocrine system; alcohol addiction;
- Hypertrophic changes in various cardiac divisions;
- Panic attacks; vegetative-vascular (neurocirculatory) dystonia.
Groups of drugs for the treatment of heart pain
Due to the variety of causes of heart pain, its diagnosis and elimination also require different approaches as well as the use of diverse medicinal options.
Organic nitrates and nitrate-like agents compose a group of pharmaceuticals used as antianginal (anti-ischemic) drugs in the treatment of IHD. The influence of nitrate-based medications causes the restructuring of hemodynamic processes; specifically, they help to relax the smooth muscles of peripheral blood vessels, resulting in a vein-dilating impact.
As a result, the influx of venous blood to the heart, the pressure in the right atrium associated with the pulmonary artery, and systemic vascular resistance all decrease.
Furthermore, the cardiac muscle is unloaded when it overcomes the resistance of the cardiac output; energy costs are reduced; and, consequently, the need for oxygen supply is lessened.
At the same time, the blood flow in the small vessels of the cardiac muscle is restored and the circulation of the epicardial arteries improves.
Among patients experiencing decreasing IHD, there is generally also a reduction in pain impulse and the cessation of pain syndrome.
In the case of ischemia accompanied by high blood pressure, medication tablets taken for cardiac pain must also have a vasodilating property.
There exists a large group of vasodilators consisting of several main subgroups that differ in terms of their mechanism of action, as follows:
- Angiotensin receptor blockers (Diovan);
- Angiotensin-converting enzyme inhibitors;
- Sympatholytic agents;
- Ganglionic blockers;
- Leukotrienes, thromboxanes, and prostaglandins;
- Myotropic vasodilators with spasmolytic action.
The organic nitrates discussed previously also have vasodilating properties.
Coronary dilating medications with reflex action
Medicines in this pharmacological group have a sedative effect. They exhibit a moderate reflex vasodilator property due to their irritating effects on sensitive nerve endings and also promote the production and release of endorphins and some other peptides, kinins, and histamine, which regulate vascular permeability and the formation of pain syndrome.
This drug group is so well-known that, if a group of physicians was asked about which pills are the best for heart pain and can be taken without fear, one of the answers given will almost certainly be one of the drugs of this group.
Drugs from the group of beta-blockers affect the activity of the sympathoadrenal system by blocking cardiac beta-1 adrenergic receptors. These drugs include all known pills like Bystolic, Tenormin and Propranolol.
A single intake of these drugs leads to a decrease in the following:
- Heart rate;
- Shock volume of blood;
- Cardiac output fraction;
- Myocardial needs regarding oxygen.
Long-term treatment with drugs of this pharmaceutical group can significantly reduce systemic vascular resistance. Their hypotensive effect is manifested by a decrease in plasma renin concentration.
To understand why it is necessary to block the so-called slow calcium (Ca) channels, it is worth reading about the value of Ca ions in the body’s activity.
- Their increased concentration (observed in IHD) contributes to an excessive increase in the processes of cellular metabolism, which leads to an increase in the need for oxygen by tissues;
- The task of these medications is to prompt a reduction in the need for oxygen by tissues (as well as myocardium);
- Because of this, there is a need for blockade of the channels through which the process of transmembrane transport of Ca ions is carried out.
Ca channels differ in complexity and variety. The main areas of their location are:
- Skeletal muscles;
- Smooth muscle vascular cells;
- Myofibrils of the heart muscle;
- Atrioventricular and sinoatrial pathways.
What tablets should I take?
Nitrates. These medicines are used for the prevention of aggravation of angina, in the complex therapy of heart failure, and during the recovery period after myocardial infarction. They are contraindicated in patients with severe hypotension, acute myocardial infarction, constrictive pericarditis, cardiac tamponade, cerebral hemorrhage, severe anemia, collapse, and shock.
Vasodilating agents. An extensive group of drugs prescribed for any form of heart failure against the background of hypertension in order to inhibit the progression of heart failure. They are contraindicated in patients with angioedema or in those with a propensity for it, those who are under the age of 18 years, during pregnancy and lactation, and with the concomitant use of certain medications.
Coronary dilating agents. Administered in patients with neuroses, mental attacks or functional cardialgia, they are contraindicated in those with acute myocardial infarction, those under the age of 18 years, those with severe hypotension, and those with cerebral circulation disorders in the acute form.
β-blockers. The medicines in this group are intended for the therapy of hypertension and the prevention of exacerbations of angina pectoris. Beta-blockers are contraindicated in severe heart failure, cardiogenic shock, cardiomegaly, hypotension, bradycardia, and second- and third-degree atrioventricular block.
Calcium channel blockers. Most of the medicines of this pharmaceutical group are used in the treatment of arrhythmia and postinfarction conditions as well as angina, tension, and unstable and chronic stable angina. Ca channel blockers are contraindicated in the atrioventricular block, bradycardia, cardiogenic shock, and weakness of the sinus node.
In order to avoid the occurrence of undesirable reactions, it is advisable that patients discuss the reception of medicines with their doctor. The use of cardiac drugs should involve a preliminary examination of the patient.