MSD Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Medications for Treatment of Coronary Artery Disease

By

Ranya N. Sweis

, MD, MS, Northwestern University Feinberg School of Medicine;


Arif Jivan

, MD, PhD, Northwestern University Feinberg School of Medicine

Reviewed/Revised Feb 2024
VIEW PROFESSIONAL VERSION
Topic Resources

The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries Blood Supply of the Heart The heart and blood vessels constitute the cardiovascular (circulatory) system. The heart pumps the blood to the lungs so it can pick up oxygen and then pumps oxygen-rich blood to the body.... read more , which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) that narrows one or more of these arteries can block blood flow, causing chest pain Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more (angina) or an acute coronary syndrome Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) (see also Overview of Coronary Artery Disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) ).

In an acute coronary syndrome, sudden blockage in a coronary artery greatly reduces or cuts off the blood supply to an area of the heart muscle (myocardium). The lack of blood supply to any tissue is termed ischemia. If the supply is greatly reduced or cut off for more than a few minutes, heart tissue dies. A heart attack, also termed myocardial infarction (MI), is death of heart tissue due to ischemia.

There are many different reasons doctors give medications to people with coronary artery disease:

  • To relieve chest pain by reducing the heart's workload and widening arteries (usually nitrates)

  • To prevent angina and acute coronary symptoms from occurring (beta-blockers, calcium channel blockers, and sometimes ranolazine)

  • To prevent and reverse coronary artery narrowing from atherosclerosis (angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], statins, and antiplatelet medications)

  • To open a blocked artery (clot-dissolving medications, anticoagulants)

Often, oxygen is given through nasal prongs or a face mask. Providing more oxygen to the heart can help keep heart tissue damage to a minimum.

Table

Nitrates

Most people are given nitroglycerin, which relieves pain by lowering blood pressure, which reduces the workload of the heart, and possibly by dilating arteries. Usually, it is first given under the tongue, then intravenously.

Morphine

Most people who have had a heart attack are experiencing severe discomfort and anxiety. Morphine has a calming effect and reduces the workload of the heart. It is given when nitroglycerin cannot be used or is not effective; however, some data suggest it may interact with antiplatelet medications Antiplatelet medications The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries, which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease that... read more and reduce their effectiveness and may slightly increase the risk of death.

Beta-blockers

Because decreasing the heart’s workload also helps limit tissue damage, a beta-blocker is usually given to slow the heart rate. Slowing the rate enables the heart to work less hard and reduces the area of damaged tissue.

Calcium channel blockers

Calcium channel blockers prevent blood vessels from narrowing (constricting) and can counter coronary artery spasm. All calcium channel blockers reduce blood pressure. Some of these medications, such as verapamil and diltiazem, may also reduce the heart rate. This effect can be useful to many people, especially those who cannot take beta-blockers or who do not get enough relief from nitrates.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers

Statins

Statins Treatment Dyslipidemia is a high level of cholesterol and/or triglycerides or a low level of high-density lipoprotein (HDL) cholesterol. Lifestyle, genetics, disorders (such as low thyroid hormone levels... read more Treatment have long been used to help prevent coronary artery disease, but they also have short-term benefit for people with an acute coronary syndrome. Doctors give a statin to people who are not already taking one.

Antiplatelet medications

People who think they may be having a heart attack should chew an aspirin tablet immediately after calling an ambulance. If aspirin is not taken at home or given by emergency personnel, it is immediately given at the hospital. This therapy improves the chances of survival by reducing the size of the clot (if present) in the coronary artery. People may also be given other types of antiplatelet medications such as clopidogrel, ticlopidine, or ticagrelor taken by mouth, or glycoprotein IIb/IIIa inhibitors given by vein (intravenously).

Clot-dissolving medications

Clot-dissolving medications (thrombolytic medications) are given intravenously to open the arteries if percutaneous coronary interventions Opening the arteries Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more Opening the arteries cannot be done within 90 minutes after the person arrives at the hospital.

Anticoagulants

Most people are also given an anticoagulant, such as heparin, to help prevent the formation of additional blood clots.

Ranolazine and ivabradine

Ranolazine and ivabradine are alternative therapies for people with angina that does not respond to the usual therapies (for example, nitrates or morphine).

PCSK-9 inhibitors

This class of medication is used for people whose levels of low-density lipoprotein cholesterol (LDL-C), which is the "bad" cholesterol, is not at the target level. PCSK-9 inhibitors, such as alirocumab or evolocumab, are used alone or in combination with other lipid-lowering medications (for example, statins or ezetimibe) for the treatment of adults with primary hyperlipidemia Dyslipidemia Dyslipidemia is a high level of cholesterol and/or triglycerides or a low level of high-density lipoprotein (HDL) cholesterol. Lifestyle, genetics, disorders (such as low thyroid hormone levels... read more Dyslipidemia , including familial hypercholesterolemia. They can be particularly useful for people who have difficulty tolerating the side effects of other medications that lower cholesterol levels.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP