| Medication and Action | Generic Name | Examples of Brand Names | Uses | Specific Side Effects | Specific Precautions |
Antiarrhythmic Agents
Medications for fast or irregular heartbeats— alter the way in which electrical currents flow through the conduction system and heart muscle. The change in the electrical characteristics of the heart may reduce the ability of a heart rhythm abnormality to begin or continue | Quinidine | Cardioquin
Cin-Quin
Duraquin
Quinaglute
Quinalan
Quinidex
Quinora | Help control various rhythm disorders | Diarrhea
Dizziness
Stomach upset
Ringing in ears
Passing out | Avoid if known sensitivity to quinine; digoxin dose will need to be adjusted because quinidine causes digoxin levels in blood to rise |
| Procainamide (tablet, capsule, intravenous) |
Procan SR
Pronestyl
Pronestyl-SR |
Lupus syndrome (blisters, chest pain, joint pain, weakness) |
Avoid if known sensitivity to procaine |
| Disopyramide |
Norpace
Norpace CR
|
Blurry vision
Urinary obstruction (men)
Dry mouth
Congestive heart failure
|
Elderly patients may be more prone to side effects; caution if milk sensitivity — tablets contain lactose (milk sugar) |
Lidocaine (intravenous)
|
Xylocaine
|
Confusion
Seizures
|
Phenytoin
|
Dilantin
|
Overgrowth of gums
Drowsiness
|
Mexiletine
|
Mexitil
|
Stomach upset
trembling, unsteadiness
|
|
Tocainide |
Tonocard |
Stomach upset
trembling, unsteadiness
Blood cell abnor-malities |
Flecanide
|
Tambocor
|
Congestive heart failure
Dizziness, visual disturbance
|
Avoid after recent heart attack |
Moricizine
|
Ethmozine
|
Stomach upset
Dizziness, headache
|
Propafenone
|
Rythmol
|
Bitter taste
Weakness
Diziness |
| Bretylium (intravenous) |
Bretylol |
Low blood pressure |
| Medications for slow heartbeats—act by affecting the nervous system's control of heart rate |
Amiodarone |
Cordarone |
Bluish skin discoloration
Overactive or underactive throid
Lung scarring (fibrosis)
Nerve damage
Spots in corneas of eyes
Liver abnor-malities
Stomach upset |
Digoxin dose will need to be adjusted because amiodarone causes digoxin levels in blood to rise; periodically have blood tests and chest x-ray, pulmonary function tests, and eye examination |
|
Adenosine |
Adenocard |
For rapid treatment of fast heartbeats originating from the upper parts of the heart (atria and atrio-ventricular node) |
Chest heaviness
Flushing
Nausea
Headache
Shortness of breath/ asthma
Slow heartbeat
Diziness
(All side effects are very brief) |
Very short-acting medication; effects enhanced by dipyri-damolel effects reduced by caffeine and certain asthma medications (theo-phyllines) |
|
Ibutilide |
Corvert |
|
Atropine (intravenous) |
|
For temporary acceleration of certain slow heartbeats |
Rapid heartbeat Mouth dryness Blurred vision Difficulty urinating |
Avoid in glaucoma, urinary obstruction |
|
Isoproterenol (intravenous) |
Isuprel |
For temporary acceleration of certain slow heartbeats |
Rapid heartbeat Blood pressure swings |
Avoid in angina |
| Beta blockers, see Table F; calcium channel blockers, see Table G. |
Although some manifestations of heart disease seem to be waning, heart failure has become an epidemic. The death rates from stroke and myocardial infarction dropped substantially secondary to the advances in medications and intervention; however, the number of patients with significant ventricular dysfunction or pump failure continues to rise.
Heart failure is not a disease per se; rather, it is a result of an injury, which can produce muscle weakness resulting in pump failure or stiffness of the muscle.The most common cause of the injury is heart attack due to coronary artery diseases. These may include any infectious process like virus, hypertension, or valve dysfunction. Other causes are discussed in more detail in a separate chapter.
treatment for heart failure, therefore, will be targeted first to treat the cause of the heart failure itself and secondly to treat the symptoms of heart failure.
Nonpharmacological approaches to treatment,such as low-salt diets, weight restrictions, and patient education on activity and medications, are certainly recommended. However, this is not enough for most patients, and many will require taking medications. After evaluating the severity of heart failure, the medications that are most commonly used are diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic blockers, angiotensin receptor blockers (ARBs), and digoxin. For details, please see graphic.
