Drugs for the weak heart!

ImageWeak Heart is a condition caused by weakness of the heart muscle where in the heart is unable to pump blood to meet the daily requirement of the body.

This condition in medical terms is called Cardiomyopathy or Left ventricular (LV) dysfunction.

This condition causes breathless on exertion initially and then breathlessnes at rest in the late stages. One is unable to sleep supine at night due to the breathlessness. It may be associated with cough and swelling of the feet. This clinical condition is called Heart Failure.

The condition is diagnosed by carrying out an Ultrasound of the heart to know its pumping function. This test is also called 2D-Echocardiography.


There are some important medications which patients need to take:

1. Diuretics: These are drugs given either orally or intravenously. These act on the kidneys by flushing water and electrolytes from the body. By flushing out water from the body, these drugs reduce the congestion in the lungs and thereby reduce breathlessness. They also cause reduction in the swelling in the feet. This causes increase in the urine output. Thus, these drugs are advised to be taken in the mornings. 

The common ones used are Furosemide, Spironolactone, Amiloride, Triamterene etc.

These can cause electrolyte imbalance and dehydration and so the therapy need to be monitored.

These drugs are recommended to patients in heart failure who are breathless and develop swelling of the feet. They relieve patients of their symptoms but are not found to reduce the  long term mortality.


2. ACE Inhibitors. This is a class of drug which acts by blocking the conversion of angiotensin I to angiotensin II. They, therefore, lower arterial resistance and increase venous capacity; increase cardiac output. They reduce the cardiac mortality in the long run and are recommended in all patients with heart failure and LV dysfunction.

The common ones used are Enalapril, Captopril, Ramipril and Perindopril. These drugs can cause increased potassium levels in the blood and can cause dry cough in come patients. If a patient in unable to tolerate the drug due to dry cough, they can be substituted with ARBs. ARBs (angiotensin receptor blockers) are similar drugs but tend to be more expensive.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.


3. Beta-Blockers: This is a class of drug which reduces sympathetic over-activity. Thereby, they reduce the heart rate and blood pressure, thus giving the heart much needed rest to recover. 

The drugs approved for this condition are Metoprolol,  Bisoprolol and Carvedilol. These drugs need to be started in very small doses and then increased carefully as some of the patient may encounter worsening of their symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

Now you know what to take if someone suffers from LV dysfunction or heart failure. 

Take care!

Watching TV in your teens? It would make you fat in your 40s!


Television viewing habits and leisure-time physical activity at the age of 16 independently predicted the metabolic syndrome at age 43, according to the first study to examine this.


More TV, less exercise, doubled metabolic syndrome! This means that these teens have  higher risk of getting obese, having higher triglyceride (type of bad fat), increased blood pressure and increased sugar levels when they reach their 40s!


In this study, 888 individuals were studied. Those who reported “watching several [TV] shows a day” at 16 were twice as likely to have the metabolic syndrome at age 43 than those who said they watched “one show/week” or less!

Similarly, those who noted leisure-time physical activity “several times per month” were more likely to have metabolic syndrome later in life than those who reported “daily” leisure-time physical activity in their teens!


TV viewing and less physical activity at age 16 years was linked to central obesity, low HDL cholesterol, and hypertension at age 43 years!

So switch off the Idiot box and go walking with your family! 


via Metabolic syndrome in 40s linked to TV, exercise, at age 16 | theheart.org.

Beware! Analgesics can kill!

medicine       We never think  twice before popping in an analgesic pill for aches and pain. But now Beware!

There is increasing evidence to show that analgesics can increase cardiac mortality and cardiovascular event rates. A recent journal publication reports that Diclofenac was found to increase cardiac events by 38 to 67%. The increased risk with diclofenac was similar to the COX-2 inhibitor Rofecoxib (Vioxx, Merck), a drug withdrawn from worldwide markets because of cardiovascular toxicity. Diclofenac is the most widely prescribed analgesic in over 15 south asian countries.

In the meta-analysis, Rofecoxib, etoricoxib, and diclofenac were the three agents that were consistently associated with a significantly increased risk when compared with nonuse.  Rofecoxib increased the risk of serious cardiovascular events between 27% and 45%, and Etoricoxib increased the risk more than twofold compared with nonuse. In two observational studies, Diclofenac increased risk of acute heart attacks by approximately 38% and 39%, respectively.

In a paper published earlier in the premier journal Circulation, analgesic use in 43000 patients with heart attack was associated with a 59% increased risk of death after one year and a 63% increased risk of death after 5 years of use.

Currently, Naproxen, is one of the analgesic found to be safe and not increase cardiac event rates in the analysis.

Next time, think twice before you pop in that analgesic pill! More so, if you have suffered a heart attack before! Instead, try some local application like hot fomentation or balms to relieve the pain!