Soothing the strangled heart

 Some years ago I accompanied my elderly client to the cardiologist. He had uncontrolled hypertension for years, resulting in an enlarged heart.

After several tests, I asked the cardiologist to 'give it to me straight' regarding my client's future. He thought for a moment then succinctly and casually responded, "Sudden death". That was eight years ago. My client is still alive and kicking at 80, the result of lifestyle changes and medications for hypertension and heart-attack prevention.

The good news is that there are countless medical therapies, including medication, which can address heart disease and its possible consequences. However, controlling blood pressure, exercising, losing excess weight, quitting smoking, managing stress, controlling blood sugar and cholesterol with diet should be among your first choices.

The heart becomes 'strangled' when its main vessels become inhabited by gunk called plaque. The arteries become hardened and, if the plaque ruptures, blood-clotting platelets move in, blocking off blood supply. Eventually, (sometimes within minutes) if this blockage is sustained, some or all of the heart muscles die from lack of oxygen, preventing the heart from pumping effectively.

A pill for every ill

The drugs we use before and after a heart attack fulfill various objectives. Some lower blood-pressure, decrease 'bad cholesterol', reduce the blood-clotting rate, clear excess salt and water from the system, decrease heart rate, strengthen the heartbeat, slow down formation of the ever-growing plaque, dilate the main clogged vessels in the heart and restore blood flow. These actions make the job of the heart easier.

An aspirin a day

Nowadays, almost everyone with heart disease is prescribed a child's dose (81mg) of aspirin per day which is an anti-clotting agent. Aspirin, although essential and available over-the-counter, is not for everyone as some of us are allergic to it, others have medical conditions or are taking other medications which indicate that we take lower doses or none at all.

Like aspirin, clopidogrel is prescribed to reduce the risk of heart attack and other serious circulation problems. Abciximab, dipyridamole and tirofiban are other anti-platelet drugs which are called 'super-aspirins'. Clot-busters (anticoagulants like heparin and warfarin) though they work differently from aspirin, clopidogrel and the others, have similar effects on blood clots.

Lowering and managing 'bad cholesterol' can decrease the chances of having a heart attack and improve survival chances after having one. The statins, fibrates, omega-3 fatty acids and others confer huge benefits in the quest to lower 'bad cholesterol'.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.