Heart And Circulation - part 2

Diuretics

Diuretic medicines are also known as 'water pills' and they help in converting surplus salt and water present in the body into urine. Two health problems are eased with the generation of additional amounts of urine. Use of diuretics prevent the tissues from retaining more water and becoming swollen (a condition called edema), while it also helps to improve the action of the heart, as a lesser volume of blood is in circulation. Diuretics belong to different classes and every one of them is employed differently, and each one has dissimilar actions as well as effects. However, one thing is common among all classes of diuretics - they all work on our kidneys, the vital organ that regulates the amount of water retained by the body.

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During the usual filtration process, the kidneys remove water, salts (mostly sodium and potassium) plus waste materials from the bloodstream. While the major amount of the water and salts taken from the bloodstream are returned to it, some amounts of it is excreted from the body in the form of urine, which also contains waste substances produced by the body. Diuretic medications work to slow down the normal action of the kidneys by means of lessening the quantities of water and sodium amounts that are returned to the bloodstream, thereby, augmenting the production of urine. Thus, the actions of diuretics help to lessen the amount of water in the bloodstream and also to remove the surplus water retained by the tissues and getting rid of them in the form of urine.

Diuretic medications belonging to all classes enhance the rate as well as the speed of passing urine. The action of the diuretics is most obvious when one begins therapy with these medications. People who have struggled with edema may possibly observe that swelling, especially in the ankles, is lessened, while people who have suffered a heart failure may possibly notice that their breathing difficulties have been eased following the use of diuretic medications.

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All said and done, use of diuretics may result in a disproportion of chemical substances present in the blood. Most frequently people using these medications experience a decline in the level of potassium in their bloodstream - a condition called hypokalemia. This disorder caused by diuretics may lead to debility, especially in aged people. Deficiency or poor levels of potassium may also cause irregular heartbeats, particularly in people who are using digitalis medications. Normally, such an imbalance in the potassium level may be treated by using dietary supplements containing high amounts of potassium or by using a medication called potassium-sparing diuretic. In addition, consuming food that have high amounts of potassium, such as lots of fresh vegetables and fruits, may prove to be effective in correcting the potassium imbalance.

A number of diuretic medications may possibly raise the uric acid levels in the bloodstream and, hence, people who are vulnerable may develop gout. Diuretics may also increase the levels of sugar (glucose) in the bloodstream, which, in turn, may result in added difficulties for people with diabetes.

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Anti-arrhythmic medicaments

The human heart comprises four chambers - two upper (atria) as well as two lower (ventricles). Generally, electrical impulses coordinate the pumping activities of these four chambers of the heart to ensure that the heartbeat is normal. When this synchronization collapses, the heart may start beating in an abnormal pace - irregularly or may be more rapidly or slowly compared to its normal rhythm. Arrhythmia is a common term that denotes abnormal heartbeats. Arrhythmia may be of different types subject to the affected area of the heart.

Any problem affecting the mechanism of the heart for regulating its rhythm may disrupt the heartbeat. A number of additional conditions may also disrupt the heart rhythm and they include use of particular medications, such as anti-cholinergic drugs; consuming beverages containing high amounts of caffeine; and a hyperactive thyroid gland.

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The heart rhythm is regulated by using a wide variety of medications, counting those belonging to the class of medicaments called beta blockers, digitalis medications as well as calcium channel blockers. In addition, medications like disopyramide, procainamide, lidocaine and quinidine are also used to control the heartbeat.

The electrical impulses controlled by the sympathetic (autonomic) nervous system manage the pumping action of the heart. The electrical impulses or signals travel via the muscles of the heart and result in the contraction of both sets of the heart's chambers - the atria along with the ventricles.

All the anti-arrhythmic medicines work to modify the transmission of the electrical impulses within the heart. However, every medication or a group of medications have a different mechanism that has an effect on the series of occurrences. While some medications, especially those belonging to the class of drugs called beta blockers, obstruct the conduction of the electrical impulses to the heart; some others, those known as digitalis medications, have an effect on the manner in which the signals are transmitted inside the heart; and there are others that have an effect on the heart muscles' response to the electrical impulses they have received (for instance, calcium channel blockers, procainamide, disopyramide and quinidine).

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Normally, anti-arrhythmic medications check the symptoms of arrhythmia and may possibly bring back the normal rhythm of the heart. While these medications are not able to check the occurrence of all types of arrhythmia, usually they lessen the rate as well as the seriousness of the symptoms related to this condition. It is unfortunate that while these medications restrain arrhythmias, several anti-arrhythmic drugs also have a tendency to slow down the normal functioning of the heart. In addition, they may also result in side effects like light-headedness when an individual is standing (a condition called postural hypotension) or panting/ breathing difficulties when they exert themselves. Some patients have also reported experiencing minor nausea and problems with their eye sight while using these medications. For instance, when used in high doses verapamil may result in constipation, while disopyramide is likely to obstruct the actions of the parasympathetic nervous system, causing some anti-cholinergic consequences.

In addition, in specific situations, the anti-arrhythmic medications are also likely to interrupt the rhythm of the heart and, hence, these medicines are only used when it is found that their benefits are more compared to the risks involved.

When used in excessive doses, quinidine may prove to be toxic, leading to a syndrome known as cinchonism. This syndrome may cause dizziness, impaired hearing, eye sight problems and even result in loss of vision. Since a number of people are especially susceptible to this medication, normally a test dose is given prior to starting the regular treatment.

Anti-angina medicaments

Basically, angina is a heart/ chest pain that occurs when there is an insufficient supply of oxygen to the heart muscles. Normally, this condition takes place owing to blood vessel constriction, especially the coronary arteries, which transport blood as well as oxygen to the muscles of the heart. The most widespread form of this disease is called the classic angina, wherein the pain is experienced usually when one exerts him/ her, or endures emotional stress. In another type of angina called variant angina, the victims experience pain while they are resting. In the instance of classical angina, the coronary arteries are narrowed owing to fatty deposits (known as atheroma) on the arterial walls. On the other hand, in the case of variant angina, the constriction of the coronary arteries occurs owing to the spasm of the fibers in the muscles that comprise the walls of the arteries.

People who smoke tobacco or those who consume foods rich in fat content experience an increase in the atheroma or fatty deposits inside the arteries. For this reason, physicians treating angina patients advise them to quit smoking as well as modify their diet, which forms a part of the complete treatment for this disorder. Even people who are obese and enduring angina are advised to lose the extra pounds with a view to reduce the burden on the heart. To a great extent, such lifestyle modifications help in improving the symptoms related to angina, often it is also necessary to undergo treatment using medications to get relief from the pain caused by angina.

Treatment of angina is primarily done by using three types of medications - nitrates, beta blockers and calcium channel blockers. The nitrates and the calcium channel blockers work to expand the blood vessels by means of loosening up the muscle stratum in the walls of the blood vessel, thereby lessening the pressure/ burden on the heart and make it easier for the heart to disseminate blood.

The beta blockers, on the other hand, obstruct the conduction of the signals or electrical impulses within the heart, thereby, decreasing the heart muscles' stimulation during stress or exercise. The action of beta blockers also lessens the heart muscles' oxygen requirement and reduces the frequency of angina attacks.

In order to control angina effectively, it may usually be necessary to treat the condition using either one medication independently or a number of medications in conjunction. Anti-angina medicines that check attacks enable the patients to engage in further exhausting activities devoid of inciting pain. In case of occurrence of an angina attack, the nitrates are effective in providing relief.

Although the anti-angina medicines usually do not produce any serious side effects, they may result in a range of insignificant symptoms. As calcium channel blockers and nitrates dilate the blood vessels all over the body, they may result in light-headedness and, occasionally fainting (particularly, when one is standing). In many cases, people using these medications may experience headaches when they begin treatment. Some of the other probable side effects include swelling in the ankles and reddening of the skin, particularly the facial skin. In addition, those using these medications may become tolerant to nitrates. Therefore, people who are constantly using nitrates to treat angina should ensure that they do not take any nitrates for about 10 hours to 12 hours every day. Use of beta blockers may frequently result in coldness of the hands as well as feet. In addition, they may cause fatigue and also a heavy sensation in the legs.

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