Winelands Cardiology is proud to be associated with Apprentice Doctor>  click here for more info
For access to Cholesterol Coach click the following Button
Contact Us

Heart Health Library

Our comprehensive guide to common heart conditions, diagnostic tests, procedures, medications, and post-intervention care.

Heart Health Library

At Winelands Cardiology, our experienced cardiologists diagnose and treat a wide range of heart diseases and cardiovascular conditions in adult patients.

Understanding your condition and treatment options is the first step toward improving your heart health and quality of life. This is why we’ve created this Heart Health Library for our patients and community.

Common Cardiac Diseases

Our team diagnoses, treats, and manages a range of heart conditions, including their intersection with diabetes. Below, we share key information about these common cardiac diseases.

Common Cardiac Procedures

Our team performs a full spectrum of heart disease treatments and interventional cardiology procedures. Below, we share what patients can expect from these common cardiac procedures.

Lifestyle Adjustments

Long-term heart health depends not only on treatment but also on lifestyle management. Below, we share the latest guidance for patients aiming to adopt a healthy lifestyle, including exercise, diet, substance use, and weight control.

Medication and Your Heart

Medication plays an important role in long-term heart health. Below, we share expert guidance on how medications might affect your cardiovascular health, including the use of statins.

Post-Intervention Care

Following any cardiac procedure, careful post-intervention care is vital. Below, we share clear discharge advice for patients who have received a coronary angiogram or pacemaker implantation.

Need assistance? Contact us

We are passionate about ensuring that every patient understands how to monitor their recovery and when to seek help. Our cardiologists and support team take the time to explain each step of your post-procedure care, empowering you to take an active role in your heart health.

If you have any further questions or concerns – whether about your medication, follow-up appointments, or lifestyle adjustments – please do not hesitate to contact us. We are here to guide you every step of the way on your journey to better cardiovascular health.

Contact Us

Powered by
►
Necessary cookies enable essential site features like secure log-ins and consent preference adjustments. They do not store personal data.
None
►
Functional cookies support features like content sharing on social media, collecting feedback, and enabling third-party tools.
None
►
Analytical cookies track visitor interactions, providing insights on metrics like visitor count, bounce rate, and traffic sources.
None
►
Advertisement cookies deliver personalized ads based on your previous visits and analyze the effectiveness of ad campaigns.
None
Powered by

Medication and your heart

Medical therapy with various tablets forms the cornerstone of management of most heart conditions. It is very important to know your medication well (names, doses, and reasons for taking them). Below are some of the most common types of medication that is used in cardiology practice. This information document should not replace the advice given to you by your doctor, cardiologist, pharmacist, or the medication information leaflet.

Aspirin

Aspirin is an antiplatelet drug (anti – against, platelets). The mechanism of action is to inhibit platelet function and therefore decreases the risk of blood clot formation within blood vessels in your body. Aspirin is most often used in patients with coronary artery disease, previous strokes, or disease of the arteries in your legs. It should be continued lifelong in these patients. The effectiveness of aspirin to reduce further strokes and heart attacks have been well documented in large trials. In patients with previous heart attacks or strokes, the small incremental risk of bleeding from aspirin as a result of the antiplatelet action is offset by the decreased risk of further strokes or heart attacks. The most important side effect is bleeding and irritation of the lining of the stomach. Overall, aspirin is very well tolerated by most patients. Aspirin should be taken with food to reduce the risk of irritation of the stomach lining.

Statins (Simvastatin; Atorvastatin; Rosuvastatin etc.)

Statins are medications that lower blood cholesterol. Hypercholesterolemia (hyper – high, cholesterol) is one of the main risk factors for coronary artery disease, strokes, and disease of arteries throughout the body. Statins can be used as therapy for primary prevention (i.e., before any stroke/heart attack has occurred), or for secondary prevention (i.e., after a stroke or heart attack has occurred). It is important to understand that evidence-based guidelines recommend very low cholesterol level targets in patients who have already suffered a heart attack or has had either stents or bypass surgery. Therefore, even if your cholesterol was not particularly high, a statin will still be indicated. Although it is important to follow a healthy lifestyle, this does not replace the need for a statin. Your cardiologist may indicate a specific cholesterol level target. If your current statin dose does not achieve that target, increasing the dose or changing to a more potent statin may be indicated. Statins may cause some muscle cramps; however, this is likely overreported and the causative link between the statin and the muscle cramps are often not well established. Statins are amongst the most important medicine in the treatment of many cardiac diseases. Unfortunately, statins have received immense negative publication which is largely unsubstantiated. (See statin summary for more information)

Clopidogrel (others in this family include Ticagrelor and Prasugrel)

Clopidogrel is another type of antiplatelet agent, like aspirin. Best available evidence recommends the use of double/dual antiplatelet therapy after placement of a stent or after a heart attack. The combination of the two antiplatelet drugs reduces the risk of stent thrombosis (clotting within the stent), a potentially deadly complication. The duration of dual antiplatelet use will be discussed with you by your cardiologist, but usually ranges from 6 months to one year. Clopidogrel, like other antiplatelet drugs’, main adverse effect is bleeding. As with aspirin, if it is used within the correct context (such as after a stent placement), then the small incremental risk of bleeding is significantly less that the risk of developing complications without the medication. Clopidogrel is taken once a day, and can be taken with or without food.

ACE - Inhibitors / ACEI (Enalapril / Lisinopril/ Perindopril)

ACE – inhibitors are one of the most commonly used antihypertensives (anti – against; hypertensive – high bloodpressure). In addition to being a very effective blood pressure lowering therapy, it has many additional beneficial effects. ACE – inhibitors reduces the degree of protein loss in the urine of patients with diabetes, as well as forming the cornerstone of heart failure therapy. In the context of heart failure, ACE – inhibitors have repeatedly been shown in large international trials to lower mortality rates and hospitalizations in patients with heart failure. If you are using an ACEI for blood pressure lowering purposes, the dose will be titrated to achieve the desired blood pressure control in addition to other lifestyle interventions. If, however you are using an ACE – inhibitor in the setting of heart failure, the aim is to achieve high doses, even when your blood pressure may not be high. Patients who have suffered a heart attack is often started on ACE – inhibitors to prevent ‘cardiac remodeling’ (The process through which chronic heart failure occurs after a heart attack). Elevated levels of potassium in the blood are one of the most serious side effects of ACE-inhibitors, and this may be screened for by your cardiologist. Some patients experience a dry cough on ACE – inhibitors. In such cases, the ACEI can be changed to another related class of antihypertensives called ARB’s (valsartan; losartan; telmisartan).

Beta-blockers (Atenolol / Carvedilol / Bisoprolol / Nebivolol)

Beta-blockers, like ACE – inhibitors, are considered blood pressure lowering therapy. It also forms one of the cornerstones of heart failure medication. It is most commonly prescribed in the setting of heart failure where it reduces the risk of dysrhythmia’s (dys – abnormal; rhythmia – heart rhythms) and it improves the survival rates and risks for heart failure related hospitalizations. Another important utility for the use of beta blockers is in patients that experience angina (chest pain related to lack of blood supply to some part of the heart muscle). Often, angina responds effectively to beta blockers, in which case a coronary stent may then not be necessary. If beta blockers are used in the setting of heart failure, they will also need to be slowly increased to ‘full guideline recommended maximum tolerated doses’, even if your blood pressure may not be high.

Mineralocorticoid receptor antagonists (MRAs) (Spironolactone / Eplerenone)

MRAs, like ACE-inhibitors and beta-blockers have at least 2 important roles in cardiology: they are potent blood pressure lowering therapy in patients with markedly elevated blood pressure, and secondly, they form another cornerstone of heart failure therapy. MRAs in the context of heart failure have been shown to reduce mortality rates and the risk for heart failure hospitalization. Like ACE-inhibitors, it may cause elevated levels of potassium in the blood. It may also cause some breast tenderness in male patients, especially with Spironolactone use. The medication is usually well tolerated and except in the unusual setting of severe adverse effects, the benefits of MRA use in the setting of heart failure significantly outweigh the risk/ side effect profile in most patients.

Diuretics (Furosemide – “Lasix” / HCTZ / indapamide etc.)

Diuretics are an important component of the heart failure therapy. Unlike beta blockers, ACE – inhibitors and MRAs (see above), diuretics have not been shown to decrease mortality rates in heart failure. However, they are very effective in decongestion (de – remove; congestion – swelling/ fluid buildup), and by doing so, result in marked improvement in swelling and shortness of breath. Most patients with heart failure are on a maintenance dose of a diuretic. Your cardiologist may recommend a dose range, where, depending on your swelling and shortness of breath, the dose may be transiently increased at home to facilitate the passage of larger amounts of urine to relieve swelling and fluid buildup. The most common side effects are dehydration and abnormalities with blood electrolytes. These side effects are uncommon at the doses usually prescribed. Diuretics are also used in the management of high blood pressure.

SGLT - 2 inhibitors (Dapagliflozin / Empagliflozin)

SGLT-2 inhibitors are relatively new agents on the market, and were initially intended as anti-diabetic medication. It was then discovered that this class of drugs is extremely effective in the management of heart failure, as well as in the prevention of kidney dysfunction – both in patients with diabetes and those without diabetes. It is now considered one of the 4 cornerstones of the medication – based management of heart failure. The medication is extremely well tolerated. There is a slightly increased risk of bladder infection, and genital hygiene is recommended. Other minor side effects were inconsistently demonstrated and is not particularly common in clinical practice.

ARNIs (Sacubitril – Valsartan / ‘Entresto’ / ‘Vymada’)

ARNIs forms the 4th and final cornerstone of the medical treatment of heart failure. It has been shown in a large international trial that ARNIs (as an alternative to ACEI or ARBs) are superior in reducing the risk of heart failure hospitalizations and cardiovascular mortality in patients with heart failure. Patients will take either an ACEI / ARB or an ARNI (not both). The medication is relatively well tolerated, and rarely can cause high potassium levels. It may also lead in some patients to angioedema, which refers to severe swelling of the tongue, neck, and face area. If this happens, the medication must be stopped immediately, and you should report this to a doctor. Like with all the antihypertensives (blood pressure lowering medication) that is used in heart failure, ARNIs significantly reduces your blood pressure. If your blood pressure is not high, then ARNIs may cause some dizziness and lightheadedness during the initiation phases. This usually improves over time, and it is important to try an become established on a full dose of ARNI if you have heart failure.

Metformin

Metformin is one of the most commonly used anti-diabetic medications on the market. It is remarkably safe, and often sufficient to normalize high blood sugar levels on its own in addition to lifestyle changes. If your blood sugar levels are very high, you may need additional medication as well, including insulin. The medication is well tolerated by most patients. Occasionally patients experience some abdominal pain and diarrhea after starting metformin, but this is usually transient and self-limiting.

Oral anticoagulants

Oral anticoagulants are medications that target the coagulation system of the blood, unlike aspirin and clopidogrel that target the blood platelets. Oral anticoagulants reduce the risk of clot formation in patients with AF, as well as patients with metallic prosthetic valves. They are also effective in ‘dissolving’ established clots in your heart, if present.

Two main groups of oral anticoagulants are currently on the market:

  • Warfarin / Coumadin: Warfarin is a well-established oral anticoagulant, and is the most commonly used anticoagulant in the world. It is the only anticoagulant that can be used in the setting of metal valve replacements (i.e.  no other anticoagulant options). Taking Warfarin can be a challenge: The efficacy of the warfarin is monitored by a test called an INR. If you are taking too much warfarin, your INR will be too high, and you are then at an increased risk of bleeding. If you are taking too little warfarin, then your INR will be low, and then you will be at risk of a stroke . It is important that your INR levels are monitored (blood test) (initially more frequently, thereafter at least monthly) to ensure that your INR level is in the desired range. Another inconvenience related to the use of warfarin is that it has many interactions with other medication and food types, especially dark green vegetables. This may lead to labile INRs.

  • Novel /New oral anticoagulant (NOACs / DOACs): This class of medication is newer on the market than Warfarin. It is now recommended in favor of warfarin, as it is more effective and associated with a lower risk of bleeding. NOACs also d not need blood level monitoring and are less susceptible to interaction with other medication and food types. Unfortunately, these medicines  are a lot more expensive than Warfarin, and medical aids may elect not to pay for NOACs unless Warfarin control has been shown to fail.

Anti-arrhythmic agents

Anti-arrhythmic agents (Anti – Against; arrythmia – abnormal heart rhythm) is a class of medication used to treat, reduce, or prevent abnormal heart rhythms. Various options are available and will be considered by your cardiologist. Common examples include Amiodarone, Flecainide, Mexiletine and Sotalol. Anti-arrhythmic agents are generally considered to be a class of agent associated with substantial risk of side-effects. Therefore, like with all medication, a careful risk – benefit analysis should be done before initiation. However, millions of patients across the world are being treated very successfully with anti-arrhythmic agents, and if you need to be on it, your doctor will advise which tests must be done routinely to monitor for adverse effects. Often these agents are used for a short period of time only thereby reducing the risk of adverse effects substantially.