• Medical Treatments for Children

    Children with heart disease, whether the disease is present at birth (congenital) or acquired later, are often treated with medication. The medications listed below are ones that are commonly prescribed to children who are heart disease patients.

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    ACE Inhibitors and Angiotensin Receptor Blockers 

    ACE inhibitors and Angiotensin-2 Receptor Blockers (ARB) are used to treat hypertension (high blood pressure) and congestive heart failure.

    Examples of ACE Inhibitors:

    •  captopril (Capoten)
    •  enalapril (Vasotec)
    •  lisinopril (Prinivil, Zestril)
    •  ramipril (Altace)
    •  trandolapril (Mavik)

    Examples of Angiotensin-2 Receptor Antagonists:       

    •  candesartan (Atacand)
    •  irbesartan (Avapro)
    •  losartan (Cozaar)
    • telmisartan (Micardis)
    • valsartan (Diovan)

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    Antiarrhythmics

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

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    Anticoagulants

    Anticoagulants are medications that prevent blood from clotting, thereby reducing the chance of a stroke or pulmonary embolus (blood clot in the lung arteries). 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:

    • warfarin (Coumadin) 
    • heparin (unfractionated)
    • heparin (low molecular weight)

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    Antiplatelets

    When you are 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 have had a procedure where artificial material is left in the body (shunt, mechanical valve, stent, etc.). Without medication, blood clots (thrombosis) can form around the 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:

    • aspirin
    • clopidogrel (Plavix)

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    Beta Blockers

    Beta blockers are a type of medicine used to treat high blood pressure, but they are also used to treat irregular heart rhythms. Children who take these medications can have slowing of their heart rates.

    Examples:

    • atenolol (Tenormin)
    • bisoprolol (Zebeta)
    • carvedilol (Coreg)
    • metoprolol (Lopressor, Toprol XL)
    • nadolol (Corgard)
    • propranolol (Inderal)
    • sotalol (Betapace)
    • timolol (Blocadren)

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    Bosentan 

    Bosentan is a medication used to treat elevated pressure in the lung arteries (pulmonary arterial hypertension). It helps to relax the vessels in the lungs. Long-term use of this medication can cause liver damage. Patients who are on this medication need regular lab tests to check their liver function.

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    Digoxin 

    Digoxin is a medication that can be used to treat fast, irregular heartbeats, such as atrial flutter or supraventricular tachycardia, or sometimes to treat heart failure. The mechanism of action is not well understood. One must be careful to take the correctly prescribed dose as taking too much digoxin can result in side effects such as nausea, vomiting, diarrhea, blurred vision, confusion, dizziness, and irregular heartbeats.

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    Diuretics 

    Diuretics are often prescribed to lower blood pressure 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 are used in some children with extra fluid in their lungs; high blood pressure; or swelling of their hands, feet, eyes, or face.

    Common examples:

    • bumetanide (Bumex)
    • chlorothiazide (Diuril)
    • furosemide (Lasix)
    • hydrochlorothiazide (Esidrix, Hydrodiuril)
    • spironolactone (Aldactone)

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    Sildenafil

    Sildenafil is a medication used to treat elevated pressure in the lung arteries (pulmonary arterial hypertension). It helps to relax the vessels in the lungs. This medication can be used for erectile dysfunction and its trade name is Viagra. When used to treat pulmonary hypertension, the trade name is Revatio. 

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    Warfarin

    Warfarin sodium (Coumadin) is a medication called an anticoagulant, commonly referred to as a blood thinner. The body naturally balances the ability to form clots with the ability to break them down. Warfarin, which is taken by mouth, reduces your body’s ability to form clots. 

    Patients who are placed on warfarin therapy are those who have certain conditions that put them at high risk of serious blood clot formation. This includes some patients with congenital heart disease. Congenital heart disease conditions where warfarin therapy is often used include:

    • After having an artificial/mechanical heart valve placed
    • After stenting [link to ] of some blood vessels 
    • In certain patients who have had a Fontan procedure
    • In patients who have had previous blood clotting problems

    Warfarin therapy requires regular blood testing (called PT/INR) to measure the body’s clotting ability. Usually this is performed at a blood draw lab, but some insurance companies will provide for home monitoring machines. You do not want the blood to clot too easily, increasing the risk for clot formation, nor do you want the blood to not be able to clot at all, which increases the risk for a major bleeding episode. There are several factors that can affect warfarin’s effectiveness in the body, including changes in diet and the use of other medications, so it is very important to have the blood test done regularly to assess the body’s clotting ability.

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