Medication can be an effective tool in treating people who have previously had a myocardial infarction, or heart attack. It can also help prevent future attacks.
Different types of medication work in different ways to meet these goals. For example, heart attack medication may help:
- lower high blood pressure
- prevent clots from forming in your blood vessels
- dissolve clots if they do form
However, you should not use heart attack medications to treat an acute myocardial infarction. There is no appropriate heart attack emergency treatment at home. A heart attack is a life threatening emergency requiring immediate treatment in an emergency room.
When to call 911
Anytime you have pain or pressure in your chest that lasts more than a few minutes and is different from the pain you’ve felt before, it’s important to get medical attention as soon as possible. This is especially important if you have other symptoms, too, such as:
- shortness of breath
- nausea or vomiting
- a sudden cold sweat
- back, neck, arm, or jaw pain
- extreme fatigue
Here’s a list of common heart attack medications, including how they work, why they’re used, and examples of each.
Beta-blockers are a class of medications commonly used to treat heart problems such as high blood pressure, chest pain, abnormal heart rhythm, congestive heart failure, and heart attacks.
These medications block the effects of adrenaline, which makes it easier for your heart to do its job. By decreasing the speed and force of your heartbeat, these drugs help lower your blood pressure. As a result, beta-blockers relieve chest pain and improve blood flow after a heart attack.
Some examples of beta-blockers for people who have had a heart attack
Metoprolol has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
- If you are taking metoprolol, be careful not to stop taking it abruptly. Doing so can increase the risk of poor blood supply to the heart and a heart attack. It may be wise to follow the same precaution with any other beta-blockers unless directed otherwise by your doctor.
Angiotensin-converting enzyme (ACE) inhibitors also
Improved blood flow can help reduce heart strain and further damage after a heart attack. ACE inhibitors may even help reverse structural changes to the heart caused by long-term high blood pressure. This can help your heart work better in spite of the damaged muscle segments caused by a heart attack.
These medications may also be used to treat chronic kidney disease.
There are three types of ACE inhibitors:
- sulfhydryl-containing ACE inhibitors like captopril (Capoten)
- phosphorus-containing ACE inhibitors like fosinopril (Monopril)
- dicarboxylate-containing ACE inhibitors like ramipril (Altace)
Additional examples of ACE inhibitors from the dicarboxylate category include:
- enalapril (Vasotec)
- lisinopril (Prinivil, Zestril)
- quinapril (Accupril).
On April 22, 2022, Pfizer issued a
ACE inhibitors have a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
- You should not take these drugs during pregnancy. They can harm or end your pregnancy. Talk with your doctor about other ways to lower your blood pressure if you plan to get pregnant. If you get pregnant while taking this drug, tell your doctor right away.
In addition to the FDA’s warning on use during pregnancy, ACE inhibitors are not safe for people who are sensitive to the drugs or any of their components, or for those who have had angioedema because of an allergy or intolerance to such a drug or any other substance.
Antiplatelet agents are typically used by people who have had a heart attack and are at risk for additional clotting. They can also be used to treat people with several risk factors for heart attack.
Others likely to be prescribed antiplatelets include people who have had a heart attack and used thrombolytic medication to dissolve a clot and people who have had blood flow restored to their heart through catheterization.
Aspirin is the most well-known type of antiplatelet medication.
However, in 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued new guidelines that aspirin should not be the primary preventive method of cardiovascular disease among adults younger than 70 years old or those who have a higher risk of bleeding.
In some cases, adults between ages 40 and 70 years old may use it in consultation with their doctor. The U.S. Preventive Services Task Force (UPSTF) has issued similar guidelines.
The reasoning for these guidelines is that long-term use of aspirin may lead to negative side effects that outweigh the benefits of its preventive capabilities. According to the
- abdominal bleeding
- bleeding in the brain
- kidney failure
Besides aspirin, antiplatelet agents include:
Many antiplatelet drugs have boxed warnings, which are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.
- Clopidogrel is broken down by your liver. Some people have genetic differences in how one of their liver enzymes works. This enzyme is called cytochrome p-450 2C19 (CYP2C19). This difference in function could make your liver process this drug more slowly, which could make the drug less effective. Your doctor may order testing to see if you have this genetic difference. If you have it, your doctor will prescribe other treatments or drugs instead of clopidogrel.
- Brilinta (including generic versions of ticagrelor) or Effient (including generic versions of prasurgel) can cause hemorrhage, or fatal bleeding. People who have had a transient ischemic attack or stroke, or those over the age of 75, should not take Brilinta or Efficient. You should avoid taking either of these drugs for at least 7 days before any surgery. You should not start them before an artery bypass graft surgery or take them if you already have active bleeding. If you do get bleeding while on Brilinta, your doctor may want to manage the bleeding without discontinuing the drug, as stopping can make bleeding worse. Avoid taking Brilinta with aspirin, as it may reduce Brilinta’s effectiveness.
Anticoagulant drugs are blood thinners, which means they reduce the risk of clotting in people who have had a heart attack. Unlike antiplatelets, they
Examples of anticoagulants include:
- heparin, which increases the activity of antithrombin III (AT3), causing an inhibition of blood clotting factors
- warfarin (Coumadin), which blocks the vitamin K epoxide reductase, an enzyme involved in coagulation activation.
- rivaroxaban (Xarelto)
- dabigatran (Pradaxa)
- apixaban (Eliquis)
Many anticoagulants have boxed warnings, which are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.
- Stopping the use of any anticoagulant prematurely can increase your risk of developing life threatening blood clots. If your specific medication is discontinued, your doctor will place you on another type to avoid this risk.
- People taking some anticoagulants while receiving epidural anesthesia or receiving a spinal puncture are at greater risk of developing a spinal or epidural hematoma.
In 2021, the
In addition to the FDA’s warnings, the Institute of Safe Medication Practices (ISMP) classifies anticoagulants as high-alert medications due to the risk of bleeding. To be safe, you should consult with a doctor before taking anticoagulants. Be sure to tell them of any other medications you’re taking to help them determine if there’s an increased risk for any interactions.
While taking these drugs, it is important that you’re monitored regularly.
Thrombolytic drugs, also called “clot busters” or fibrinolytics, are used immediately after a heart attack. They may be used when angioplasty can’t be done to widen the blood vessel and improve blood flow to the heart. A doctor may also prescribe thrombolytic therapy in conjunction with surgery.
A thrombolytic is given in a hospital through an intravenous (IV) tube. It
Examples of thrombolytic medications include:
- alteplase (Activase)
- streptokinase (Streptase)
There are many types of medications that can help treat heart attacks and prevent them from happening again. They work in different ways to help reduce your risk factors and improve your heart’s function.
If you have had a heart attack, your doctor will talk with you about the specific medications that can help you recover and prevent additional attacks.