Drug Therapy

Beginning in the late 1950s, doctors began to make great strides in the fight against heart disease. In 1959, Swedish doctors implanted the first pacemaker in a 43-year-old man. In 1961, researchers at Johns Hopkins University found that a combination of simple and easily learned resuscitative techniques such as CPR could keep heart-attack victims alive long enough to get them to a hospital and more sophisticated care.

We have learned more about the causes of heart disease and the roles life-style and diet play. In addition, we have now refined surgical techniques like valve replacements and transplants to treat damaged hearts.

Researchers developing medications for heart disease have had a wide range of problems to deal with. We've needed drugs first to forestall heart and vascular disease, then to correct the resulting conditions. Many new drugs have been developed and tested. The first real breakthrough came with the discovery of a surprisingly versatile group of drugs called beta-blockers, but we still find extremely useful some drugs discovered more than two centuries ago.

There are a wide variety of drugs that are commonly used to treat patients with heart diseases.

Digitalis

Digitalis (Digitoxin and Digoxin) is a drug class that was first discovered 200 years ago by Dr. William Withering in an ingredient in foxglove, a common flower in English gardens. It was used to treat a condition called dropsy, which we know today as congestive heart failure. It occurs when an overworked heart can't pump enough blood to meet the body's circulatory needs.

Digitalis affects the heart muscle by invigorating it and causing it to pump with more force. By beating more powerfully and pumping more blood with each beat, the heart doesn't have to beat as quickly. This also explains the drug's other effects. By strengthening the heartbeat, it almost magically reverses the symptoms of congestive heart failure. Blood passes through the kidneys more quickly, enabling them to eliminate the excess fluid and salt; a heart that has enlarged may shrink back toward its normal size. The overall result is an improvement of circulation throughout the body. Digitalis continues to be an extremely useful drug. Nonetheless, there are limits to what it can do. Today this drug and others may be combined in a comprehensive cardiac care program.

Nitroglycerin

Nitroglycerin and related drugs trace their ancestry to the chemist's test tube. Amyl nitrite, first synthesized in 1844, was quickly found to cause flushing of the face due to the relaxation of the tiny blood vessels known as capillaries. Twenty-three years later, a young Scottish medical student by the name of Thomas Lauder Brunton suspected that amyl nitrite might also relieve angina by increasing blood flow to the heart. It wasn't long before nitroglycerin, which is chemically similar to amyl nitrite, was discovered to have a similar effect, relaxing the smooth muscles that are part of your arteries, allowing them to dilate. Both drugs are still used for treatment of angina, but nitroglycerin is by far the more common, because it is more easily administered and has fewer side effects.

One new way of delivering nitroglycerin (as well as some other drugs) is by means of a transdermal patch. For years doctors have known that nitroglycerin is easily absorbed into the bloodstream through the skin. There are nitroglycerin ointments that can be spread on the skin, tablets that are held under the tongue or in the cheek until they dissolve, and capsules that can be swallowed. The advantage of transdermal patches, which look like big adhesive bandages, is that they r