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Heart Attack Treatment

Medical treatment of ischaemic heart disease has to take two forms: chronic long-term treatment for anginal pectoris and intensive emergency treatment for myocardial infarction.

Treatment of Angina Pectoris
What are the objectives of medical treatment of anginal?
The medical treatment of angina is directed towards:

Alleviation and prevention of attacks of angina.
Increasing exercise tolerance.
Prevention of myocardial infarction.

How are the attacks of angina treated?
The aim of the treatment is to prevent the attacks from occurring as far as possible and to control the attack if and when it occurs. The sheet-anchor of the treatment is nitrates. The short but quick acting nitrates such as nitroglycerine (Angised) are used to treat the attack. The drug is kept under the tongue, which causes rapid absorption of the drug so that the effects appear within a couple of minutes. The patient should also stop all activity in order to reduce the oxygen demand of the heart. The medium acting nitrates, such as isosorbide dinitrate (sorbitrate), and longer acting nitrates such as mononitrate are used to prevent attacks of angina from recurring. Nitrates are drugs which ought to be given freely. The patient can and should take more than the dose prescribed, if necessary, without hesitation. The only side effect is headache, which is harmless and gradually becomes less and less troublesome.
Other drugs used for the treatment of angina are calcium channel blockers (nifedipine, diltiazem) and betablockers ( Atenolol, Inderal).

How do you increase the exercise tolerance?
Nitrates increases the exercise tolerance. Such tolerance should be further increased by gradually increasing the quota of exercise in the form of walking and encouragement to take part in non-competitive games. ( See Chapter 10).

How do you prevent infarction?

Aspirin in small doses is given to prevent clotting of blood on the atheoma in the coronary artery. This prevents infarction. Only 50 - 150 mg daily of soluble aspirin ( Colsprin 100) is all that is necessary for this beneficial effect. Larger doses reduce the beneficial effect to the heart and incidence of bleeding complications increases. Aspirin should be taken dissolved or suspended in a glass of water after meals to prevent any irritant effect on the stomah which can cause ulcer of the stomach. Alternatively, take enteric coated aspirin tablet (ASA-50 Ecosprin - 75) which does not need to be dissolved in water. Aspirin is not to be taken if there is any history suggestive of ulcer dyspepsia. In that case your physician will prescribe some other suitable drug such as dipyridamole ( Persantin).
Cadioprotective drugs such as betablockers are given not only to treat angina and associated hypertension but also to protect the heart from overstrain during physical exertion.
The dose of all the above-mentioned drugs has to be individualized. They must, therefore, be taken strictly in accordance with the advice of your physician.

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