These cardiac disorders can be treated in the following ways. Click on the disorders below to find out more.

Angina

Drugs used for angina include:

• Glyceryl trinitrate, taken sublingually (under the tongue) for rapid relief of symptoms or before activities that are likely to cause symptoms
• Beta-blockers or calcium channel blockers to reduce the chance of an angina attack
• Other medicines, which can also be used preventatively, e.g. long-acting nitrates such as isosorbide mononitrate, nicorandil, ivabradine and ranolazine.

Patients may also be offered medication to reduce the risk of cardiovascular disease, which is often called secondary prevention. This might be low-dose aspirin to make the blood less sticky so it flows more easily, and a statin to lower blood cholesterol and cut the chance of fatty deposits forming in the blood vessels. Patients with diabetes may also be offered an angiotensin-converting enzyme (ACE) inhibitor as this drug class helps protect against kidney damage, which diabetics are at increased risk of. There are also lifestyle measures that can help.

Myocardial infarction

Primary treatment – dealing with the immediate medical emergency – depends on the severity of the heart attack and the speed with which the patient has got to hospital. If it is within 12 hours and the diagnosis is STEMI, a procedure to widen the coronary artery (coronary angioplasty) is usually carried out, plus blood-thinning medication, for example aspirin, heparin or clopidogrel. If the procedure is not available – not all hospitals do it – a clot busting medicine is likely to be given instead, such as streptokinase, plus a drug to prevent any blood clots getting bigger, such as tirofiban or eptifibatide. For NSTEMI, blood thinners are usually given. Many patients also receive drugs to reduce pain and nausea, such as morphine and metoclopramide.

Secondary management is concerned with reducing the risk of another MI. The drugs used usually are:

• An ACE inhibitor to reduce blood pressure
• An antiplatelet agent to prevent blood clots forming
• A beta-blocker to reduce the strain on the heart by causing a decrease in heart rate and blood pressure
• A statin to lower blood cholesterol.

Heart failure

Medication for heart failure can be complicated, but some of the more common drugs used include:

• Diuretics, such as furosemide, to relieve fluid retention
• ACE inhibitors or angiotensin receptor blockers (ARBs), which reduce the amount of fluid in the body and make blood vessels wider, meaning the heart has to do less work
• Beta-blockers
• Mineralocorticoid receptor antagonists (MRAs), e.g. spironolactone, to ease fluid retention.

Cardiac arrhythmias

Management for arrhythmias involves sorting out any underlying conditions, such as heart failure, and then medication. A procedure such as cardioversion (which shocks the heart back into a normal rhythm) or catheter ablation (destroying any diseased tissue in the heart that is contributing to the abnormal rhythm); or having a device fitted such as a pacemaker or implantable cardioverter defibrillator (ICD), both of which work to keep the heart beating normally and regularly, may also be options.

Practice points

• Think about how you and your team can promote healthier lifestyles to patients
• How can you and the team increase recruitment to the NHS Health Check?
• Find out where patients can be signposted to have an NHS Health Check if this service is not provided at your pharmacy.