Drugs and surgery Patsy Westcott Doctors have been treating heart disease for hundreds of years, and some remedies (such as digitalis from foxgloves) are still widely used, but modern drugs mean many people with heart disease can lead a relatively normal life.

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Treatments for heart disease aim to do one or more things :

• Improve blood flow through the coronary arteries - by dilating the arteries, for example
• Reduce the build up of atherosclerosis
• Help the heart muscle to work better, allowing the heart to act more efficiently as a pump
• Change the electrical control of the heart, so influencing the rhythm, for example by slowing the heart when it beats too fast, or preventing abnormal rhythms, such as atrial fibrillation
• Thin the blood to improve flow, stop clots from forming and prevent a heart attack
• Reduce the strain on the heart, for example by controlling blood pressure

There are a range of drugs doctors can use to treat heart disease. Many people will find that they're advised to take several different medicines together, depending on the nature of their heart problem and whether they have risk factors such as high blood pressure.

As with any medication, side-effects can be a problem. But as there are usually different versions of any particular type of drug, your doctor will usually be able to prescribe an alternative if a drug doesn't suit you.

We've listed some of the main categories of heart drugs. For specific information on a medication you've been prescribed, contact your doctor or pharmacist.

ACE inhibitors

Angiotensin Converting Enzyme inhibitors (ACE inhibitors) are used to treat heart failure and high blood pressure. They work by blocking the formation of a hormone, angiotensin II, which narrows the blood vessels around the body, and makes the body retain fluid.

Lowering angiotensin II levels lets the blood vessels relax and expand. This lowers blood pressure and makes it easier for the heart to pump blood around the body. ACE inhibitors also help to reduce the amount of blood in the body, taking even more strain off the heart. It can take several months for the full benefits of ACE inhibitors to develop, but it's worth the wait – they reduce the risk of dying from heart failure by up to 40 per cent.

Angiotensin II receptor antagonists (or blockers)

Commonly called ARBs, these are a newer type of drug that work on the same system as ACE inhibitors. They prevent the hormone angiotensin II from acting on the cells. They may be used in heart failure and to lower blood pressure. Some research suggests they have fewer side-effects than ACE inhibitors.

Anti-arrhythmic drugs

These control the rhythm of your heart and how fast it beats. There are different types of anti-arrhythmic drugs, which work in different ways.

One of the most widely used is digoxin. It's used to treat one of the commonest rhythm problems, atrial fibrillation. It's important that levels of digoxin are carefully controlled, so it should be taken exactly as instructed, and regular blood tests may be needed.

Anticoagulants

These are used to inhibit blood clotting, especially in atrial fibrillation when the upper chambers of the heart beat fast and irregularly. This can cause clots that may shift to the brain and cause a stroke. They're also used to keep the circulation flowing smoothly when someone has artificial heart valves, to treat deep vein thromboses (clots in the legs) and to prevent these from travelling to the lungs where they may cause a pulmonary embolism (blood clot on the lungs).

The downside of anticoagulant treatment is the risk of haemorrhage. People taking these drugs need regular tests to ensure they're anti-coagulated to the correct degree, and should seek urgent treatment if they have a fall or injury.

Aspirin and antiplatelets

These prevent blood clotting in the arteries by reducing the stickiness of blood cells called platelets, which are involved in clotting. This helps to improve blood flow in narrowed coronary arteries and reduces the risk of a blocked artery leading to a heart attack. Aspirin can reduce the risk of dying from a heart attack by 25 per cent or more. These drugs are also used after heart bypass surgery to prevent blood clotting.

Beta blockers

These are used to prevent angina, treat high blood pressure and improve heart failure. They work by blocking the effects of stress hormones, which make your heart beat faster and more forcefully. By slowing the heart and also relaxing the arteries throughout the circulation, the heart doesn’t have to work so hard, which helps in heart failure. Beta blockers also lower the risk of another heart attack if you have already had one, and/or help control abnormal heart rhythms (arrhythmias).

Calcium channel blockers

There are different types of calcium channel blockers and they have differing effects. Some relax and dilate the blood vessels and are used for treating angina, high blood pressure and heart failure, while others slow the rate at which the heart beats and are used to treat abnormal heart rhythms.

Diuretics

These drugs, often referred to as 'water tablets', may be used to control blood pressure or remove excess fluid from the body in heart failure. They act by increasing the excretion of water and sodium by the kidneys.

Nitrates

Nitrates dilate the coronary arteries. This improves blood flow to the heart muscle, which helps to relieve angina. Glyceryl trinitrate (GTN) is a commonly used nitrate. It's in the tiny pills, or spray, that people put under their tongue during an angina attack. Dilation of the arteries reduces the work the heart has to do to pump blood around the body, so nitrates are helpful in heart failure, too.

Statins

These drugs are used to help reduce the amount of cholesterol in the blood. High levels of cholesterol are a risk factor for heart disease. By lowering unhealthy levels of cholesterol, the risk of CHD and heart attacks is reduced.

Thrombolytic drugs

This group of drugs has radically improved the treatment of, and survival from, heart attacks in the past decade. They dissolve clots that form in a coronary artery and trigger heart attacks.

If the drugs are given quickly enough - within a couple of hours of onset of a heart attack - they'll restore the blood flow through the artery in time to avoid permanent damage to the heart muscle. The earlier this treatment's given, the better.

However, because the drug thins the blood it can cause brain haemorrhage (stroke) in a significant number of patients

Side-effects

Many heart drugs have minor side-effects, but most settle down in time. Your doctor and/or pharmacist will alert you to any side-effects and what you should do about them, and you'll also find details in the information leaflet that comes with your medication. If you develop any unexpected effects, or if you're worried, contact your doctor.