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Heart attack

Medication for heart attacks & side effects

People who have had a heart attack will usually need to take medication for the rest of their lives.

Most will take a combination of drugs including' an antiplatelet drug, such as aspirin abd clopidogrel, which interferes with the blood's clotting mechanism; an ACE (angiotensin converting enzyme) inhibitor, which relaxes the arteries enabling blood to flow through them more freely; a beta blocker which slows down the heartbeat' and a statin which helps to lower cholesterol. Those who are likely to experience angina will be given a nitrate (GTN tablet or spray). Other drugs for lowering high blood pressure may also be prescribed.

 

James discusses the medication he is taking and its side effects.

James discusses the medication he is taking and its side effects.

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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How often do you need to take them?
 
I take four tablets in the morning, that's aspirin, citalopram which I still take which is a relax, yeah to relax me, my bisoprolol – actually that's the only three I take because of course actually those three in the morning now. Sorry I was still, I, originally it was four because I was on clopidogrel as well which was a blood thinning drug which obviously I've stopped taking after a year having just stopped taking that so, it's only three in the morning and two in the evening which is the anti-statin and another bisoprolol. I take a small bisoprolol in the morning and a small one at night so they split during the day.
 
So the statin has been working very well and that's been working well for me you know to keep my cholesterol down. Prior to that it was higher from a test I'd had done for years, done years ago now but where I think it was 4 or something but it, it dropped down to 2.5 on this one. My last one I had from the hospital was 2.5, that's the one I remember and my doctor says it's always between 2.5 and 3 and that's the reading so not to worry on that.
 
Have you had any problem, any side effects with any of the drugs apart from the one that you were telling me about?
 
Yeah the ramipril. I think probably when I first started taking statins was, it's not really a side effect. I'd I didn't feel too well, I felt a bit lethargic and a little bit achy but that is part of the, the effect of the drug. You know it was just an achy sensation – so nothing to worry about, it passes with time but of course you have to, there's no pain without gain as they say.

 

Some people need to take many medicines, others will be able to reduce the number as they progress. It will depend on many things including; how much the heart was damaged by the heart attack and the state of the coronary arteries.

A few of the people we talked to said they didn't like the idea of taking tablets long term and were hoping to reduce them eventually, but all considered the drugs to be essential. Some people had reduced the number of pills or the dosages of the pills they took over time and most said they got used to taking their tablets. Those who took several pills a day said they used a pill box to help them to remember to take their medication.

 

Taking medication is a routine you get used to. He warns people to get advice if they have side...

Taking medication is a routine you get used to. He warns people to get advice if they have side...

Age at interview: 61
Sex: Male
Age at diagnosis: 49
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Taking tablets is a routine you have to get in to. Most of mine I take first thing in the morning. I'm supposed to take one at midday or rather half way between the morning one and the night time one. So it's not quite midday, it's usually the middle of the afternoon and I frequently have to be reminded about that one. 

But it's not critical that one, so that is one of the things that can be a bugbear, you can almost get to hate your tablets and I know people who've really got quite upset about the idea of having to take tablets and I try and put the point of view, well you'd be a lot worse off without them and it's a small price to pay for getting back an almost normal lifestyle. 

So it doesn't represent a problem for me that. I'm quite happy to take the tablets, particularly because I know so much about what they do for you, and I understand why you've been given them and how much worse I'd feel without them. But I guess there are a lot of people out there who are not taking all of their tablets, because they've had what they think is an adverse reaction and instead of telling somebody they've just decided to take themselves off the tablet. 

But I still think that a lot of people don't mention to their GPs, or the practice nurse that they're not taking some of the tablets because they've had perhaps an adverse reaction and there can be, but people mustn't just accept that and say I'm not taking that. They must go back and say, 'this is happening, what can we do about it?' The drugs can be changed, there are others that will do the same job with perhaps different effects. So that's important.

  

 

Describes the benefits of using a pill box.

Describes the benefits of using a pill box.

Age at interview: 58
Sex: Male
Age at diagnosis: 57
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I find that brilliant because I'm on such a lot tablets, if you open that, there's like, you put Monday's 

Is it a pill box?

Yes, it's absolutely excellent because before I bought that, that was my wife's suggestion, I used to have to get that lunch box twice a day and go through every one, which it takes me about half an hour on a Sunday, put the entire weeks up, twice a day and then that's it for the week then. 

It's a very good investment that is. It's got nothing to do with the fact, oh you can't count, it's purely convenient. If I've got to take my tablets now, it's a thirty second process, instead of ten minutes getting everything out and I find it really good.

Sometimes when people are taking several different drugs, getting the right combination of medicines can take time. Because drugs affect people differently it is important to talk to a doctor about any side effects - it is often possible to change medication.

Some people we spoke to experienced no or few side effects. Among those who did have side effects, many persevered with the medicine and said they were tolerable when weighed against the possibility of having another heart attack.

 

He has side effects but reckons this is a small price to pay and they don't interfere with his...

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He has side effects but reckons this is a small price to pay and they don't interfere with his...

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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Have you experienced any side effects from your medication ? 

Yes, plenty, both real and imagined. There was a time when I thought the statin I was taking was responsible for the pain in my hand and wrist, but that was just wishful thinking. However I do experience a number of real effects, but only one is becoming a nuisance and may need a change of medicine. 

I have a frequent and very irritating dry cough, which can escalate almost to a kind of retching. I've recently had a bad spell of bronchitis and I suspect all the coughing and hacking brought it on. My GP reckons it might be due to the beta blocker I am taking and is reviewing the situation.

It does take me time to get up to speed these days and I think that is a consequence of the medication as a whole. For example, if in the morning I walk a few hundred yards around the corner and up a short incline to the post box, I feel completely knackered by the time I get there. If, however, I continue walking for a few more minutes I get into my stride and can walk briskly for miles. It's a bit like doing a warm up period in the gym before getting stuck in.  

I also experience a number of minor reactions; my digestion is upset most of the time to the point of threatening to become inconvenient - I have a small supply of anti-diarrhoea pills just in case but have not yet had to use them; for a good part of the day my fingers are white and cold due to a restricted blood supply but other parts are quite the reverse. 

Unfortunately this is principally my nose, which lights up like I'm a bottle a day man. Apart from the coughing it's all minor stuff that doesn't interfere with my life. It's a small price to pay and I'm not complaining.

 

The side effects from his medication are tolerable when weighed against the possibility of having...

The side effects from his medication are tolerable when weighed against the possibility of having...

Age at interview: 62
Sex: Male
Age at diagnosis: 56
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Was sort of always conscious that there must be some medication that they could give that wouldn't produce the side-effects that were so, I mean literally having, always having streaming eyes and nose and then like a chesty complaint all the time. With the best will in the world, the GPs and the cardiologists, try this, try that. 

I wouldn't say it was almost shots in the dark, I mean clearly they would have said try this for a particular reason, but I seem to be one of these people that always had negative side effects but physically was, was fairly sound I thought.

I've always had these side-effects which I've never been particularly happy about but I'm reconciled to it and believe that, that's, that's life. You know, there will be side-effects with this medication, which is quite powerful. The side-effects are tolerable when you weigh it against the possibility of a further heart attack or sort of anything like that.

The side effects we were told about included' dizziness, cough, feeling sluggish, upset stomach, headaches, arm pains, flu like symptoms, blurred vision, wind, forgetfulness, irritability and tiredness. A couple of people became constipated or were allergic to aspirin and were prescribed a different antiplatelet drug, such as clopidogrel.

When a metal mesh (called a stent) is used to keep the artery open after an angioplasty, an anti-clotting drug usually clopidogrel is prescribed for a year afterwards. Bruising was one reported side effect and Neil found that it clashed with the medicine he was taking for his acid reflux. Anti-clotting drugs such as clopidogrel may also present problems for people needing surgery.
 

John talks about the side effects of taking Clopidogrel.

John talks about the side effects of taking Clopidogrel.

Age at interview: 67
Sex: Male
Age at diagnosis: 67
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Clopidogrel the main impact of that is I bruise very, very easily and slight knocks, I’ve got some massive bruises on my arm which looks as though I have been assaulted by something. I threatened my wife that I’d say it was her but it can be just a gentle knock and because it’s stopping the clotting it just bleeds and so you get these huge bruises. If I go for a blood test I know that I’m going to have a massive bruise on my arm. And if I just nick myself shaving it takes a lot of stopping. It’s not like bleeding to death or anything but it, whereas normally it would have clotted up very quickly now I have to really press on it for quite a long time to stop it. So that’s been a slight disadvantage to that and it’s a slight worry because you think, if I’m in a car accident or something like that ambulance has got to be there a hell of a lot faster than it normally would to avoid me bleeding out.

 

 

Omeprazole appears to have an effect on clopidogrel. So Neil’s anti-acid medication has been...

Omeprazole appears to have an effect on clopidogrel. So Neil’s anti-acid medication has been...

Age at interview: 65
Sex: Male
Age at diagnosis: 62
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Did any of the drugs clash because?
 
They did clash but I only found out recently they were clashing. Because I’ve got high blood pressure as well which of course was another risk factor for me. The [mutter]. Oh no and I’ve got gastric reflux. That’s probably from smoking all those years. They put me on a tablet which reduces the effectiveness of the blood thinner by up to 25%.
 
And that is lansoprazole?
 
That is omeprazole with clopidogrel. So they’ve switched me now to lansoprazole. Which I’m told doesn’t have the same effect on the blood thinner.
 
And which blood thinner are you taking?
 
Clopidogrel. But I spoke to the pharmacist before I spoke to the doctor and the pharmacist said, ‘Well it’s not proven yet.’ He said, ‘Perhaps you ought to see your doctor’. So I went to see the doctor and she changed the tablets anyway but she wasn’t aware of it. And the next time I saw her she said, ‘You were absolutely right about the lansoprazole and the clopidogrel’. She said, ‘Thank you very much’. Which I thought was nice. So yeah it was all changed around.

 

 

John was diagnosed with prostate cancer shortly after his heart attack. Clopidogrel prevents him...

John was diagnosed with prostate cancer shortly after his heart attack. Clopidogrel prevents him...

Age at interview: 67
Sex: Male
Age at diagnosis: 67
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Then they put me on clopidogrel which of course is a very, very powerful blood thinner, anticoagulant. They put me on to a ß-blocker and then they. What else did I have? Oh yeah I was on statins and sorry I was also on a olmesartan [olmesartan medoxomil] before any of this had happened to reduce blood pressure. So they kept me on the Olmesartan and, don’t think, there’s one other drug. I can’t think what it is offhand which they then said to me, ‘You need to keep on this for the rest of your time here and you’ll have to be on the clopidogrel for a year at least because they don’t want the stent thrombosing. And so that’s and that has been a major problem because when I then got, just after I came out and I saw the urologists and the oncologists who wanted to operate on the prostate because it was 8 on the Gleason Scale which is pretty high up on the Gleason Scale. But they couldn’t operate because of the clopidogrel and hence the compromise was radiotherapy for that.
 
So I’m now going to have two months of radiotherapy every day or every weekday I should say. So that’s something coming up. But it’s amazing how one medication impacts everything else.
 
So the radiotherapy was decided by your consultant around your needs?
 
Yes, yeah.
 
As an option to surgery?
 
Yes. Because of the clopidrogel they can’t. You can’t possibly contemplate surgery because it’s too aggressive, the type that I’ve got, they can’t use the radioactive grains that they can use in some cases. And so it’s only a one choice, there is no choice. Its radiotherapy or just being held on Zoladex [goserelin] which is the sort of hormone implant that I’m on at the moment just to hold it because Zoladex turns off testosterone and because prostate cancer thrives on testosterone. So it’s…
 
So that was the only alternative that would. But then to keep you on Zoladex for a long period of time actually brings a risk of, guess what, heart attack [laugh]. So yeah it’s all wound in with one another.
 

 

A few had experienced dizziness or a persistent dry cough when taking certain ACE inhibitors. One man talked to his doctor who prescribed a different ACE inhibitor and his cough disappeared. Another was advised by his doctor to take the pill in the evening so he would be less likely to notice the dizzy spells. One man said he could feel his heart beat loudly when he took the ACE inhibitor at bedtime, which frightened him until he was told that it was normal.

 

Ramipril made him feel dizzy and he now spaces his medication out throughout the day.

Ramipril made him feel dizzy and he now spaces his medication out throughout the day.

Age at interview: 53
Sex: Male
Age at diagnosis: 49
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And you said the medications that you were on, have you had any side effects from any of those?                                          

Yes I think I still get them to this day. I feel it's worse in the morning because I take most of them first thing in the morning but I space them out, and I feel light, slightly light-headed. When I first took them I felt really dizzy but that's worn off a bit, I've got used to them. But what I do now is take them quite early in the morning; I take the first two about 5ish, I take the ramipril [an ACE inhibitor] and the aspirin. 

Then I have to take the ramipril twice a day, so I take the next one at 5 o'clock in the evening, which was what my GP recommended to space them out at 10 hour intervals and it has helped to an extent although I still get occasionally a little bit light headed, especially if I've been sat down for a while or if I've been in bed and I get up quickly.

 

The ACE inhibitor made his heart beat loudly when he took it at bed time.

The ACE inhibitor made his heart beat loudly when he took it at bed time.

Age at interview: 51
Sex: Male
Age at diagnosis: 51
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I take two aspirin and then I have a beta-blocker and an ace inhibitor; that's four. And then I take another ACE inhibitor in the evenings as well. That was a funny thing because the ACE inhibitors, I have another one in the evening and I usually go to bed you know, well it's bedtime I take the pill and go to bed. And as you lie in bed waiting to go off to sleep, the ACE inhibitors which if I'm right they open up the arteries. 

They really make your heart beat loudly, you can really feel your heart beating. Which in the first few weeks while I was home, I said, 'There's something wrong here, I'm getting worse, this is terrible.' But we've got a doctor friend and well we've got two or three people that have had heart attacks that we know of. 

Speaking to them, this is quite normal. I've lost an artery; there are other arteries that are having to do the work and they've got extra blood to carry and because I've just taken an ACE inhibitor, they all open up a little bit and they feel strange, they feel different. And there've been times when I've lain on the bed in the evening waiting to go to sleep and I felt that I could feel every artery in my chest sort of pulsing, carrying blood around. 

But I've been told this is quite normal, so I've learnt to live with that now. And sometimes if it's early evening and there's nothing else that I was doing, I take the pill then and while you are reading the paper or watching television, doing something you don't notice it actually. It's just that when you go to bed and you've taken the pill, the pill is sort of in first mode of action really and it's opening up all those arteries and making them feel very strange.

Many people who took a beta-blocker said they felt sluggish and felt it slowed them down. Others noticed their hands and feet got cold easily. A few who had low blood pressure had problems at first getting the right dosage of beta blocker. Beta blockers can cause erectile difficulties in men. None of the men we interviewed mentioned that they had experienced this side effect.

Many people said they did not experience side effects from the statin. Two women had noticed that they were losing some of their hair every time they brushed it and one also had nightmares. Another whose muscles had seized up was taken off the statin by her doctor. One man had pains in his leg and his tongue became swollen.

 

A cough, some hair loss and vivid dreams are the side effects of her medicine.

A cough, some hair loss and vivid dreams are the side effects of her medicine.

Age at interview: 63
Sex: Female
Age at diagnosis: 63
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As a result of taking the medicine, I've found that I've had quite a few reactions to the medicine. We changed one, more or less a month after I'd started and the second one, the statins; we changed about two months ago. 

I'm having a look and see if this [new] statin's any better. The side-effects were, or are should say, a cough which gets worse for a period of a couple of weeks, recedes slightly but never actually goes and then, then returns again. 

My hair is falling out quite severely. I've lost a good volume of my hair severely, and I've been having horrendous dreams at night. Really worrying dreams, really complicated dreams that I have no way to sort out. There's no way that my mind can get round the problem that's presented in this dream. 

And so those three are the three main side effects that I've had from the tablets. They still are continuing, they're still there and I'm just hoping I can get a reasonable cocktail that will eliminate at least one of them or two of them.

 

Her muscles seized up so her doctor took her off the statin.

Her muscles seized up so her doctor took her off the statin.

Age at interview: 84
Sex: Female
Age at diagnosis: 81
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I couldn't take the cholesterol tablet because I got seized up all my muscles seized up. And thought well I don't suffer from arthritis I never have, why can't I walk. I got out of bed and fell on the floor. 

So I crawled to the toilet and then I crawled back again and I thought something's wrong and as I made myself get up, and there was tears running down my face, I must get up, I must stand and I was in terrific pain but gradually the pain went. 

Next day same thing. So I saw the doctor and he said, 'Ah' he said, 'yes I know what's happened. It's these tablets, cholesterol tablets no longer agree with you so we'll stop them.' Stopped them, no problem, no problem at all. 

He gives me the cholesterol test every so often, I've got to go for another one in December, so that's, he's keeping an eye, an eye on that. There might be something he can give if he finds the cholesterol is getting too high.     

                                                

Many who took a GTN spray felt reassured by having the spray with them all the time in case of an angina attack. One man who wasn't prescribed nitrate drugs when he left hospital asked his GP for a GTN spray for his own reassurance and peace of mind. Some said that they had an immediate headache when they took nitrate drugs, which passed in a few minutes, or they felt light headed and weak for a short time, but all said it was effective in controlling their angina attack.

One man explains that at first he had trouble taking the GTN spray but he had now got used to it. A few people said that they felt uncomfortable about taking the spray if they had an angina attack in a public place.

 

Taking the GTN spray was difficult at first but he soon got used to it.

Taking the GTN spray was difficult at first but he soon got used to it.

Age at interview: 51
Sex: Male
Age at diagnosis: 51
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But I wouldn't recommend anyone doing what I did because I was here on the farm after about three or four weeks, still wearing this spray around my neck and doing something in the yard, getting excited about doing something, I can't remember what it was even. 

And I thought I better take a spray here, I'm not feeling too good and then I wasn't very used to using this spray, you have to aim it under your tongue you see. 

And the first one I sprayed mostly on my teeth, I thought well that's no good. So I sprayed again and it went on my lip and it wasn't until the third one, I tried again the third time that I actually sort of satisfied myself that I've got it on, because I was panicking and thinking about angina and everything else. 

Gave myself three doses of this spray and I fell over. I completely collapsed, I just couldn't believe it. It just, it lowers the blood pressure so much that it's virtually zero. And when I hit the ground, I woke myself up again and I staggered in and Lynn [my wife] was here and gave me a cup of tea and sat down and didn't do anymore for the day. 

But that frightened me, I thought is this another heart attack but of course it wasn't. But that [GTN] spray is pretty powerful stuff.

Had they given you any warning that might happen?

No, no, when I left the hospital it came with my pack of pills and another [GTN] spray and the nurse had told me then that if you do feel angina or any chest pain, give yourself a spray under the tongue or she said, even two if it's bad, so I thought two would be all right. But I hadn't had any experience of using it, you see. 

When I was in hospital I did have it administered for me, the nurse said hold your tongue up and just sprayed it in for me, which was easy. When you do it yourself the aim is a bit doubtful. So you get used to that. I didn't expect it to hit me like that either. 

Of course it says on the packet, that's something that I learned, if you read the label, the slip that comes with the pills because a lot of these frights that I had with the sort of palpitations and feeling arteries pumping with blood. I thought gosh you know what's happening here, this is another heart attack. 

Then one day I took the tablets all out and I took out the little leaflet that comes with them and saw all the contra-indications and when you read all the things that could happen with the pills and the side-effects and how you should take them and everything, yeah, that's me, that's what happened and it's not so unusual. 

So I would recommend anyone who gets pills, not just to read the box but read the slip inside as well.

 

It is difficult using the GTN spray in public but it is very effective in controlling his angina...

It is difficult using the GTN spray in public but it is very effective in controlling his angina...

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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Well I refused to allow it [angina] to affect my life. What I did, I had the GTN spray. As soon as I knew it was coming on, I'd have a quick spray, I'd wait a few minutes, then on I'd go again and sometimes it was difficult if you've got company, you just can't bring it and spray it in company or in the middle of the dance hall. 

Sometimes I got caught out and then it was really, really bad. I'd sit down and crawl away in the corner, spray the GTN spray, then wait five or ten minutes for it to go away. 

Sometimes it was a bit difficult. Generally speaking I got it down to a fine art and the dawn of realisation that I was getting worse and worse, I knew it just couldn't go on forever. But it was quite a worrying time at the time.

Taking that spray, the actual effects of it, was that okay, what was it like taking the spray?

No problem at all, I just took it. It's just a little bit bitter in your mouth I suppose, and then you sit there and wait a few minutes and then you feel the pain in the arms have all gone.

Last reviewed June 2017.

Last updated June 2017.

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