It is important to remember that not all congenital heart patients will require medication. If the patient does require medication, this will depend upon their specific heart condition and the nature of their symptoms.
When a drug is prescribed, it is always best to check with your clinician:
- The name
- The reason for giving it
- When and how it should be taken (i.e before or after meals)
- Interaction with any other medicines being given at the same time
- How long the patient will need to take it for
- Any possible side effects
There are various categories of medication used, and several of these are described below:
1) Anti-arrhythmic medication
These are used to control irregular or abnormal heartbeats (arrhythmias). Common drugs used include Amiodarone, Disopyramide, Flecainide, Lignocaine, Mexilitene, Sotalol and Verapamil.
These are used to treat infections, as in patients without heart disease. Common antibiotics include penicillins (Penicillin and Amoxicillin), cephalosporins (cephalexin, known as Keflex), macrolides (erythromycin, known as E-Mycin; clarithromycin, known as Biaxin; and azithromycin, known as Zithromax) and fluoroquinolones (ciprofloxacin, known as Cipro; levofloxacin, known as Levaquin; and ofloxacin, known as Floxin).
Infective endocarditis, also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. Infective endocarditis is uncommon, but people with some forms of congenital heart disease have a greater risk of developing it.
Infective endocarditis causes growths or holes on the valve or scaring of the valve tissue, most often resulting in a leaky heart valve. Without treatment, endocarditis is a fatal disease. In many cases of endocarditis, antibiotics alone can cure the infection.
Dental Procedures and Infective Endocarditis
Those more at risk may be classed as people who have:
- A prosthetic heart valve or who have had a heart valve repaired with prosthetic material
- A history of endocarditis
- A heart transplant with abnormal heart valve function
- Certain congenital heart defects including
- Cyanotic congenital heart disease (birth defects with lower oxygen levels than normal), that has not been fully repaired, including children who have had surgical shunts and conduits.
- A congenital heart defect that has been completely repaired with prosthetic material or a device for the first six months after the repair procedure
- Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.
Please note, taking antibiotics just to prevent endocarditis is not usually recommended for patients who have procedures involving the reproductive, urinary or gastrointestinal tracts. This is patient dependent - make sure you ask your cardiologist.
Brushing, flossing and visiting your dentist regularly helps prevent tooth and gum infections that could lead to endocarditis.
These are primarily prescribed to prevent blood clots forming. These are ‘blood-thinners’ and are used in patients who have an artificial heart valve, in order to prevent blood clots forming in the valve. Warfarin is most commonly used, however, regular blood tests are essential to assess the amount of thinning and to adjust the dose. To this end, many home testing kits are now available for patients to use. Newer anticoagulants such as Apixaban (Eliquis), Dabigatran (Pradaxa) and Rivaroxaban (Xarelto) are also used.
(hazard triangle clipart) IMPORTANT: Any medicines containing Aspirin should normally be avoided when taking Warfarin or any other anticoagulant, as Aspirin is also an anti-coagulant. Aspirin is sometimes used in children with heart conditions as it reduces the stickiness of the platelets in the blood.
Heparin is used via intravenous infusion to keep the blood thin, for example, during heart surgery or cardiac catheters.
Sometimes drugs are used to dissolve blood clots, for example, Streptokinase or TPA (tissue plasminogen activator). These clots may occur following surgery, catheters or at other times, especially if the blood is very thick (polycythaemic).
4) Antipulmonary hypertensives
Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. This can be caused by any problems in the blood flow through the pulmonary arteries to the lungs and then to the left side of the heart; any problem could have a backwards effect on this circuit and affect the pulmonary arteries. The antipulmonary hypertensives such as Sildenafil and Dipyridamole are used.
Digoxin is occasionally used in the treatment of various heart conditions, namely atrial fibrillation and atrial flutter. It works by increasing the force of contraction of the heart muscle, making it more efficient, and it also slows down the electrical impulses within the heart. It is used to give extra support to the heart muscle and to slow down the heart if it is beating too fast. It can occasionally make the patient sick or nauseated and they may also lose their appetite.
Chlorothiazide and Frusemide enable the kidneys to produce more urine. When the heart is not working very efficiently it causes the body to retain fluid within the lungs and the liver. Consequently, the lungs become heavier and work less efficiently causing the patient to become breathless, which often results in difficulty in feeding babies. These drugs tend to excrete potassium, sodium and chloride in the urine and supplements of these substances are sometimes needed.
Amiloride and Spironolactone are slightly weaker diuretics that do not cause the excretion of potassium. They are often used together with one of the other diuretics.
These are drugs given on the intensive care unit to increase the efficiency of the heart. They are often used for a short time after heart operations. Examples are Adrenaline, Dobutamine and Milrinone.
This drug also reduces the rate and force of contraction of the heart muscle. It is used to treat fast heart rates (tachycardia), high blood pressure (hypertension) and to relieve the spasms of the heart muscle in Fallot’s Tetralogy. There are many similar drugs, e.g. atenolol, metoprolol, nadolol, bisoprolol.
9) Pulmonary vasodilators
These are given to treat pulmonary hypertension, by the action of reducing the lung pressure. They may be breathed in after heart surgery (e.g. nitric oxide) or taken by intravenous infusion (e.g. Prostacyclin) or they may be taken by mouth (e.g. Bosentan or Sildenafil)
This can safely be given if the patient has a temperature. Use the recommended dose as shown according to the age of the patient.
Vasodilators act by increasing the size of the blood vessels and reducing blood pressure. They can also be used to lower high blood pressure (hypertension), but can also be used if the heart action is weak, as by reducing the blood pressure it reduces the workload of the heart. Commonly used vasodilators include Captopril, Enalapril and Lisinopril.