Treatment Options for Congenital Heart Disease

Medications

Patients of all ages with congenital heart disease (CHD), whether the disease is present at birth or acquired later, are often treated with medications. The medications listed below are ones that are commonly prescribed to CHD patients.

1. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-2 receptor blockers (ARBs) ­– These medications are used to treat high blood pressure (hypertension) and congestive heart failure.

Examples of ACE Inhibitors include the following:

• Captopril (Capoten)
• Enalapril (Vasotec)
• Lisinopril (Prinivil, Zestril)
• Ramipril (Altace)
• Trandolapril (Mavik)

Examples of ARBs include the following:

• Candesartan (Atacand)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Telmisartan (Micardis)
• Valsartan (Diovan)

2. Antiarrhythmics – Antiarrhythmic medications are a group of medicines that are used to treat irregular heartbeats.

There are four classes of antiarrhythmics:

• Class I, sodium channel blockers – These medications prevent sodium from getting through cell membranes, which can slow electrical impulses in the heart muscle. Examples include disopyramide (Norpace CR and Norpace), flecainide (Tambocor), mexiletine (Mexitil and Namuscla), propafenone (Rhythmol), and quinidine (Cardioquin, Cin-Quin, and Quinidex).
• Class II, beta blockers – These medications slow down the heart rate by blocking hormones such as adrenaline. Examples include atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren).
• Class III, potassium channel blockers – These drugs prevent potassium from getting through cell membranes, which can slow down electrical impulses in all of the heart’s cells. Examples include amiodarone (Pacerone), bretylium (Bretylium), dofetilide (Tikosyn), dronedarone (Multaq), ibutilide (Corvert) and sotalol (Betapace and Sorine).
• Class IV, nondihydropyridine calcium channel blockers – These drugs block calcium channels in the heart muscle, which can decrease heart rate and contractions. Examples include diltiazem (Cardizem CD and Taztia XT) and verapamil (Verelan PM extended release and Verelan delayed release).

Other antiarrhythmic drugs not included in the classification system listed above include the following:

• Adenosine (Adenocard and Adenoscan)
• Digoxin (Lanoxin)

3. Anticoagulants – Anticoagulants are medications that prevent blood from clotting, thereby reducing the chance of a stroke or a blood clot in the lung arteries (pulmonary embolism). This is especially important if the patient has undergone a procedure where artificial material is left in the body (shunt, mechanical valve, stent, etc.).

Examples of anticoagulants include the following:

• Warfarin (Coumadin)
• Heparin (unfractionated)
• Heparin (low molecular weight)

4. Antiplatelets – When you’re healing from an injury, your blood begins to clot because of platelets. These are cell fragments in blood that clump together to prevent bleeding. Antiplatelet therapy is prescribed for patients who have problems with forming clots too easily or who’ve had a procedure where artificial material is left in the body (shunt, mechanical valve, stent, etc.). Without medication, blood clots (thrombosis) can form around a stent or other material and block blood flow or break free and cause a blockage elsewhere in the body, which can result in a heart attack, stroke, or even death.

Examples of antiplatelets include the following:

• Aspirin
• Clopidogrel (Plavix)

5. Diuretics – Diuretics are often prescribed to lower blood pressure in order to reduce fluid in the blood vessels, body tissues, and lungs. They cause your body to get rid of salt and water through increased urination. They’re used in some children with extra fluid in their lungs; high blood pressure; or swelling of their hands, feet, eyes, or face.

Examples of diuretics include the following:

• Bumetanide (Bumex)
• Chlorothiazide (Diuril)
• Furosemide (Lasix)
• Hydrochlorothiazide (Esidrix, Hydrodiuril)
• Spironolactone (Aldactone)

6. Endothelin receptor antagonists – These medications are used to treat people with pulmonary hypertension by helping to slow the progression of the condition and possibly even reversing some of the damage to the heart and lungs.

Examples of endothelin receptor antagonists include the following:

• Bosentan (Tracleer)
• Ambrisentan (Volibris)
• Macitentan (Opsumit)

7. Phosphodiesterase 5 (PDE 5) inhibitors – These medications are used to treat people with pulmonary hypertension. They help slow the progression of the condition and may even reverse some heart and lung damage.

Examples of PDE 5 inhibitors include the following:

• Sildenafil (Revatio; also used to treat erectile dysfunction under the trade name Viagra)
• Tadalafil