Treatment of the myocardium is aimed at restoring the blood supply to its damaged areas (perfusion) and the function of their conductivity, limiting the zone of localized necrosis of cardiomyocytes, and activating the cellular metabolism.
In clinical practice, drugs of several pharmacological groups are used. In acute coronary syndromes and occlusive thrombosis of the epicardial coronary artery, reperfusion therapy with thrombolytic drugs (Streptokinase, Prourokinase, Alteplase) and antiplatelet agents (Ticlopidine, clopidogrel sulfate or Plavix) is performed.
In chronic heart failure, drugs that inhibit blood pressure regulating angiotensin-converting enzyme (ACE inhibitors): captopril, enalapril, ramipril, fosinopril are used. Their dosage is determined by the cardiologist, depending on the specific disease and ECG readings. For example, Captopril (Capril, Alopresin, Tenziomin) can be administered at 12.5-25 mg three times a day before meals (inside or under the tongue). As side effects of this drug and most of the drugs in this group, tachycardia, falling blood pressure, kidney failure, liver failure, nausea and vomiting, diarrhea, urticaria, increased anxiety, insomnia, paresthesia and tremor, shifts in the biochemical composition of the blood including leukopenia). It should be borne in mind that ACE inhibitors are not used for ideopathic pathologies of the myocardium, increased blood pressure, stenosis of the aorta and vessels of the kidneys, hyperlastic changes in the adrenal cortex, ascites, pregnancy and childhood of patients.
With IHD and cardiomyopathies, anti-ischemic drugs of the group of peripheral vasodilators, for example, Molsidomine (Motazomin, Corvaton, Sidnofarm) or Advokard can be prescribed. Molsidomin is taken orally - one tablet (2 mg) three times a day; contraindicated with low blood pressure and a state of cardiogenic shock; the side effect is a headache.
Antiarrhythmic and hypotensive drug Verapamil (Verakard, Lekoptin) is used in IHD with tachycardia and with angina pectoris: on a tablet (80 mg) three times a day. There may be side effects in the form of nausea, dry mouth, intestinal problems, headache and muscle pain, insomnia, hives, heart rate disorders. This remedy is contraindicated for severe heart failure, atrial fibrillation and bradycardia, low blood pressure.
Cardiotonic and antihypoxic action is medicated by Mildronate (Meldonium, Angiocardil, Vasonat, Cardionate and other trade names). It is recommended to take one capsule (250 mg) twice a day. This tool can be used only for adult patients and is contraindicated in cases of cerebral circulation disorders and the presence of structural pathologies of the brain. When using Mildronate, there may be side effects such as headaches, dizziness, cardiac arrhythmia, shortness of breath, dry mouth and cough, nausea, and bowel disorders.
Preparations of the group of β1-adrenoblockers in IHD (Metoprolol, Propranolol, Atenolol, Acebutolol, etc.), primarily reduce blood pressure, and by reducing the sympathetic stimulation of receptors on the membranes of myocardial cells reduce heart rate, reduce cardiac output, increasing consumption oxygen cardiomyocytes and alleviating pain. For example, Metoprolol is prescribed one tablet twice a day, Atenolol is enough to take one tablet a day. However, the drugs of this group increase the risk of acute heart failure and blockade of the atria and ventricles, and their use is contraindicated in the presence of congestive and decompensated heart failure, bradycardia, circulatory disorders. Therefore, at present, many specialists question the antiarrhythmic effect of these drugs.
Relieving pain in the heart is of paramount importance, since sympathetic activation during pain causes narrowing of the blood vessels and increases the burden on the heart. To stop the pain, it is customary to use Nitroglycerin. Details in the article - Effective pills that relieve pain in the heart
Doctors recommend taking vitamins B6, B9, E, and to maintain the conductive system of the heart - drugs containing potassium and mania (Panangin, Asparcum, etc.).
In infarcts with lesions of the coronary arteries (leading to the formation of a site of myocardial ischemia and its akinesia with the expansion of the heart chambers), surgical treatment is shown to restore blood flow in the heart - aortocoronary bypass.
In coronary heart disease, coronary dilatation (dilating the lumen) - stenting.
Surgical treatment is most often used for a dyskinetic aneurysm: either by an aneurysmectomy (resection), or by suturing the aneurysmal cavity (aneurysmoplasty), or by strengthening its wall.
A method of dynamic cardiomyoplasty has been developed, which involves the restoration or increase of myocardial contractility using an electrically stimulated skeletal muscle (usually a flap of the latissimus of the back) wrapped around the part of the heart (with a partial resection of the second rib). The muscle flap is sewn around the ventricles, and its synchronous stimulation with cardiac contractions is carried out with the help of intramuscular electrodes of an implantable cardiomyostimulator.