Dr Brian A Gould

Treatment/Medications and Pacemakers

Full details for each medication can sourced from the EMC website

Many cardiac medications are used to treat several cardiac conditions.


Beta blockers, e.g. Atenolol, Metoprolol and Bisoprolol.
Calcium Channel Blockers. There are two types – those that slow the heart rate and those that don’t.
Verapamil and Diltiazem slow the heart rate - Nifedipine and Amlodipine do not. The last two are usually added to a beta blocker.
Nitrates - Dilate the coronary arteries and improve blood flow.
Ivabradine - Also slows heart rate facilitating the heart muscle to extract more oxygen.
Ranolazine - How it works is unknown but it is an effective medication.

Heart Attack

There are various types of heart attack but following most you are likely to have been fitted with a stent. You will also have been advised to take several different types of medication.

These include:
In addition another anti-platelet agent Clopidogrel, Prasrugrel, or Ticagrelor;
Angiotensin Converting Enzyme Inhibitors i.e. ACE inhibitors, e.g. Ramipril or similar;
High dose statin, i.e. Atorvastatin 80 mgm, once daily;
Beta blocker;
Mineralocorticoid Inhibitor, e.g. Eplerenone or Spironolactone.

Heart Failure

Diuretics Furosemide - Bumetanide, Metolazone.
ACE Inhibitors, e.g. Ramipril or other Ace inhinbitors, e.g. Lisinopril or Perindopril.
If intolerant to ACE inhibitors Angiotensin Receptor Blockers ARB’s, e.g. Candesarten or similaragents may be used.
Mineralocorticoid Inhibitor, e.g. Eplerenone or Spironolactone.

High Blood Pressure

ACE Inhibitors, e.g. Ramipril or similar.
If intolerant to ACE inhibitors Angiotensin Receptor Blockers ARB’s, e.g. Candesarten or similar.
Calcium Channel Blockers.
Nifedipine and Amlodipine; less often Verapamil and Diltiazem.
Diuretics, e.g. Indapamide or bendrofluazide.
Alpha Blocker: Doxazosin.
Beta Blockers

In certain cases you may require a certain type of pacemaker (Cardiac Resynchronisation known as CRT) to pace both sides of the heart, which increases the amount of blood pumped out each time the heart beats. This may also improve underlying cardiac function and outcome over time.


Beta Blockers;
Bisoporolol - Sotalol.
Calcium Channel Blockers.
Verapamil and Diltiazem.
Dronaderone: A multi channel blocker used to treat Atrial Flutter or atrial fibrillation.
Amiodarone: Has multiple sites of action in the heart.
Anticoagulants for Atrial Fibrillation or Atrial Flutter.

Depending on your risk score you may be advised to take an anticoagulant to reduce the risk of stroke.

Warfarin is the established anticoagulant but it requires regular blood tests to check the efficacy of the treatment.

Newer Oral Anticoagulants (see new treatments), e.g. Apixaban, Rivaroxaban and Dabigatran.


If your heart rate is very slow you may require a pacemaker. A small device implanted under the skin to stop the heart beating too slowly.

Newer pacemakers (Cardiac Defibrillators) can also shock the heart back to normal if the heart stops due to ventricular fibrillation or ventricular tachycardia.