Advice after your nerve block for surgery
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Introduction
There are several different medications that may be used to prevent further damage to the heart and to control angina symptoms. Your doctor will decide which medications are right for you. You will not be taking all the medication mentioned in this booklet.
It is important for these treatments to be taken regularly to reduce the risk of a further heart attack or angina pain.
Ideally medication should be taken at the same time each day in order to maintain levels in the body.
Do not stop taking these medications without medical advice.
Why Take These Medicines?
To reduce your risk of having another cardiac event & to control symptoms and improve quality of life.
These are evidence based medicines, proven to be safe and effective.
GTN
This is available as tablets or a spray. They both work very rapidly as they are absorbed under the tongue. The difference is that you can spit out the tablets if you experience a headache.
Nitrates relax muscles in veins and arteries; this widens the vessels and so improves the supply of oxygen to the heart.
Possible side-effects include a throbbing headache, flushing or dizziness.
Glyceryl Trinitrate may be used to prevent ‘predictable’ attacks, meaning taking them before doing something that usually brings on an angina attack.
Do not do this without specific instructions from your doctor.
Aspirin
Aspirin works by reducing the ‘stickiness’ of platelets. Platelets are tiny particles in the blood that help the blood to clot if a blood vessel is cut. However, if a blood clot forms inside a blood vessel that takes blood to heart muscle, it blocks the flow of blood. This can cause a heart attack.
The usual dose of Aspirin is 75mg each day. This is a lot less than the dose for pain relief. Always take with or after food to reduce irritation to your stomach.
An uncommon side effect is bleeding in the stomach or gut. See your doctor if you experience persistent stomach upset, indigestion, blood in vomit, or black faeces (stools).
Antiplatelets
Examples: Clopidogrel, Prasugrel, Ticagrelor
They are usually taken in combination with aspirin after a heart attack or stent insertion.
These drugs bind to platelets, inhibiting activation and aggregation and so reducing the stickiness of blood.
They are usually taken for a fixed period depending on your condition, but your consultant may recommend that they are taken for life.
Side effects of indigestion, nausea, diarrhoea may occur. There is also an increased risk of bleeding so see your doctor if you develop any unusual bruising or blood in your stools or urine.
Ticagrelor may also cause shortness of breath.
ACE (Angiotensin Converting Enzyme) Inhibitors
Examples: Ramipril, Perindopril, Lisinopril, Enalapril
These are used following a heart attack to reduce the workload of the heart. They can also be used to treat high blood pressure and heart failure.
ACE Inhibitors work by blocking an enzyme (chemical) found in the bloodstream called ‘angiotensin’. Blocking this enzyme widens blood vessels, and lowers blood pressure, which eases the burden on the heart. ACE Inhibitors also appear to have a direct action on the heart that is protective.
A relatively common side-effect is a dry irritating cough, if this persists or is troublesome an alternative may be prescribed. Tiredness, headaches, diarrhea, abdominal pain and rashes may also occur.
Regular blood testing of kidney function is necessary for all patients taking this medication. Blood tests for kidney function for patients on ACEI should be 6 to 12 monthly, once on a stable dose. The shorter interval is for patients with reduced ejection fraction.
Angiotensin II Inhibitors (ARB)
Examples: Losartan, Irbesartan, Candesartan.
These medicines can be used as an alternative to ACE Inhibitors if the side-effect of cough is troublesome. Regular blood testing of kidney function is necessary for all patients taking this medication. Blood tests for kidney function for patients on ARB should be 6 to 12 monthly, once on a stable dose. The shorter interval is for patients with reduced ejection fraction.
Beta Blockers
Examples: Atenolol, Metoprolol, Bisoprolol
These medicines reduce heart rate and so protect the heart. They can also be used to control angina, lower blood pressure and control an abnormal heart rhythm.
Beta-blockers work by ‘blocking’ the action of certain hormones such as adrenaline. These hormones increase the rate and force of the heartbeat, particularly when you exert yourself. Taking a beta-blocker blunts any increase in the rate and force of the heartbeat.
It is important that, once started, beta-blockers are not stopped suddenly as this can cause an increase in blood pressure and angina. Do not stop taking unless told to do so by your GP.
Side effects include tiredness or dizziness (especially if your blood pressure and heart rate are reduced too much) and coldness in hands or feet.
Report any symptoms to your doctor if they persist.
If you have diabetes you need to be aware that beta-blockers may dull the warning signs of a low blood sugar level. For example, you may not develop palpitations or tremor that can occur as the blood sugar is reducing.
If you have asthma or chronic obstructive pulmonary disease (COPD), beta-blockers may narrow the airways and may make breathing symptoms worse. Your doctor will consider this before prescribing.
Statins
Examples: Simvastatin, Atorvastatin, Rosuvastatin
These are used to reduce the level of cholesterol in the blood. Cholesterol is a chemical made in the liver from fatty foods that you eat. It is composed of both HDL (high density lipid) and LDL (low density lipid) cholesterol. High amounts of LDL-cholesterol can increase the risk of developing atheroma (small fatty lumps) in the arteries. High levels of HDL help to protect against atheroma.
Statins block the action of a certain enzyme (chemical) in the liver, which is needed to make cholesterol.
Take once daily. Do not drink grapefruit juice whilst taking this medication. Possible side effects include headaches, abdominal pain, nausea and vomiting and rash.
A rare side effect of statins is a severe form of muscle inflammation so let your doctor know if you have any unexplained muscle pains, tenderness or weakness. Occasionally statins can affect your liver so liver function tests should be rechecked 3 months after starting treatment and annually if no changes.
You should have a fasting blood test 6 – 8 weeks after starting this medication and your GP should review whether this tablet is lowering your cholesterol enough.
Aiming for a total cholesterol of 4mmols or below,
HDL greater than 1mmol and a LDL below 1.4 mmols.
Dose Changes
Your prescribed heart tablets are designed to provide you with protection and reduce the risk of a further cardiac event.
Some of these tablets have to be started at a small dose with the aim of increasing the dose over time to achieve greater protection.
We recommend you contact your GP within 1 – 2 weeks after discharge to discuss reviewing these medications.
It would be helpful to let your GP know if there are any improvements in your symptoms, or concerns about any new symptoms or changes in well-being. If more convenient, check out your concerns with your local pharmacist.
What happens if I can’t tolerate the Medications?
Discuss with your doctor, nurse specialist or pharmacist. Be specific, the more information the better.
DO NOT stop taking medications without discussing with us.
General Hints
Use the same pharmacy
Be aware of different brand names & preparations for a generic drug.
Access a Prepayment certificate via www.
Oral supplements -Buying over the counter medicines can interact with your medication or increase the risk of suffering from a side effect. E.G. high dose fish oils may increase bleeding risk. Discuss further with your local pharmacist.
Sources of further medication information
Community Pharmacists
British heart foundation www.
www.
www.
Medicines Information, Frimley Park
Flu Vaccination
The Department of Health recommends that individuals with heart disease receive the flu vaccine. It is free if you have heart disease and you should be vaccinated against flu every winter to make sure you are protected against the latest strains of flu. Contact your GP to organize your vaccination.
For further information
Please contact the Cardiac Disease Risk Management team at Frimley Park on 0300 613 6384.
Office Hours: 8.00am – 4.00pm, Monday to Friday
There is an answer phone facility available on this number. Please leave a message if we are unable to take your call. We always reply, although on some occasions this may not be on the same day.
Contact us
If you have any queries relating to this information, please contact the Cardiology service.
About this information
Service:
Cardiology
Reference:
C/014
Approval date:
8 August 2025
Review date:
1 August 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.