MODERN APPROACHES TO PHARMACOTHERAPEUTIC TACTICS IN MANAGING PATIENTS WITH ACUTE FORMS OF ISCHEMIC HEART DISEASE

Abstract

Considering the high and increasing prevalence of ischemic heart disease worldwide, the high frequency of lifethreatening complications, and the multitude of risk factors, the constant updating of knowledge in the clinical-pathogenetic, diagnostic, and pharmacotherapeutic aspects of managing such patients becomes extremely relevant. According to WHO data, ischemic heart disease is the leading cause of mortality in Ukraine among life-threatening conditions. In medical practice, the disease is classified into acute and chronic forms. This paper focuses on the main diagnostic and pharmacotherapeutic aspects of acute forms of ischemic heart disease. The first step is the immediate determination of a working diagnosis, on which the treatment strategy will be based, considering the presence of pain symptoms, changes in the electrocardiogram (ECG), laboratory markers, echocardiography at rest, and coronary angiography. Regarding the pharmacotherapy direction for acute forms of ischemic heart disease in the hospital setting, the following measures are employed: analgesic, anti-ischemic, and hypolipidemic therapy; restoration of coronary blood supply; and other groups of medications. The alleviation of pain holds paramount importance. Among narcotic analgesics, preference is given to morphine, while non-narcotic analgesics are contraindicated. Oxygen should only be administered to patients with dyspnea, hypoxia, or heart failure. Anti-ischemic drugs reduce myocardial oxygen consumption by decreasing heart rate, lowering blood pressure, attenuating left ventricular contractility, or inducing vasodilation. The treatment with hypolipidemic agents should commence during hospitalization, as early as possible, with high doses, as they are associated with early and sustained clinical benefits. Antithrombotic and fibrinolytic therapy is employed to restore blood flow at the site of thrombosis (thrombolysis), counteract or reduce thrombus formation, and prevent recurrent thrombosis. Percutaneous coronary intervention remains the primary method of reperfusion therapy for patients with acute coronary syndrome (ACS) and a high risk of ischemic complications. It has been proven that cardiac catheterization with subsequent revascularization prevents recurrent ischemia and/or improves short-term and long-term treatment outcomes. For secondary prevention, the prescription of the following medications is recommended: aspirin, P2Y12 receptor inhibitors, beta-blockers, statins, ACE inhibitors/ARBs, and lifestyle modifications. Information regarding the specificities of etiopathogenetic therapy for acute forms of ischemic heart disease is essential for a wide range of healthcare professionals from various specialties to ensure the maximum effective management of such patients.