There is no cure for coronary heart disease. However, proper treatment can slow or even halt the progression of atherosclerosis so that the coronary arteries do not become further narrowed. Treatment can also help reduce the risk of a heart attack in people who have coronary heart disease.
One of the most prevalent causes of heart attack is the buildup of plaque in the arteries leading to the heart. Balloon angioplasty is a common surgical treatment for this condition. If successful, the procedure eliminates the need for more involved surgery such as coronary bypass.
The first step in fighting coronary heart disease is to make lifestyle changes to reduce risk factors. Doctors recommend that heart patients eat a low-fat diet and keep their blood cholesterol low. Most physicians believe LDL should be less than 100 mg/dl for patients with coronary heart disease. Patients are also encouraged to quit smoking, exercise regularly, and control high blood pressure and diabetes mellitus through diet or medication. (Coronary Bypass, Treatment Coronary Heart Disease)
If a low-fat diet cannot reduce a personís cholesterol sufficiently, doctors may prescribe a cholesterol-lowering drug such as lovastatin, simvastatin, or pravastatin. Many different drugs are available to control angina. Nitroglycerin and similar drugs are the oldest such medications. More recently, two other types of drugs have become available, beta blockers and calcium channel blockers. All of these medications decrease the heartís oxygen demand (by slowing the heart rate or making the heart contract less vigorously), increase the heartís blood supply, or both. Sometimes patients may take a combination of these angina-relieving drugs. Finally, aspirin is sometimes recommended to help prevent a heart attack. Aspirin interferes with platelets, blood cells that are involved in blood clotting. In this way, the drug helps prevent the formation of a clot in a coronary artery. (Coronary Bypass, Treatment Coronary Heart Disease)
Some patients may still suffer from angina even after making lifestyle changes and taking various medications. These patients may undergo coronary artery bypass surgery or percutaneous transluminal coronary angioplasty (PTCA) to help relieve their symptoms. In bypass surgery, a surgeon removes a length of blood vessel from elsewhere in the patientís bodyóusually a vein from the leg or an artery from the wrist. The surgeon then attaches one end of the blood vessel to the aorta and the other end to the coronary artery downstream of the blockage. Surgeons today commonly use an artery from the inside of the chest wall because bypasses made from this artery are very durable. The surgery creates a conduit for blood to flow through that bypasses the area narrowed by atherosclerosis. Sometimes multiple bypasses are created if more than one blockage exists. Bypass surgery became widely used in the early 1970s and is now performed on about 519,000 patients in the United States each year. (Coronary Bypass, Treatment Coronary Heart Disease)
PTCA, often known as balloon angioplasty, is an alternative to bypass surgery, especially for patients with less extensive coronary artery disease. In this procedure, first performed in 1977, a catheter with a deflated balloon at its tip is threaded through the patientís arteries to the site of a blockage. The balloon is then inflated, crushing the atherosclerotic plaque and restoring normal flow of blood through the artery. Although balloon angioplasty is initially effective in most cases, a blockage may return after only a few months, resulting in a repeat artery narrowing known as restenosis. Cardiologists, physicians specializing in treating heart disorders, may use an expandable metal scaffolding called a stent to help prevent restenosis. The stent is placed in the artery at the time of angioplasty and helps keep the artery open. Nearly 600,000 balloon angioplasty procedures are performed in the United States each year. (Coronary Bypass, Treatment Coronary Heart Disease)
When a person who may be having a heart attack arrives in the emergency room, doctors usually perform an ECG, which shows telltale changes when a heart attack is occurring. They may also order blood tests to detect the presence of chemicals released by injured heart muscle cells. The patient may be given drugs such as nitroglycerin and beta blockers, which decrease the heartís oxygen demand and help limit the amount of tissue damaged in the heart attack. Some patients are treated with a drug that dissolves blood clots, such as streptokinase or tissue-type plasminogen activator (t-PA). These drugs are most effective when given within an hour of the onset of chest pain. Other patients may have emergency balloon angioplasty or bypass surgery to restore blood flow to the heart muscle. (Coronary Bypass, Treatment Coronary Heart Disease)
After a heart attack, a patient may remain in the hospital for several days. At first, he or she may stay in a coronary care unit (CCU), an intensive care unit designed specifically for heart attack patients. In the CCU, the patient is monitored constantly with an ECG, and specially trained doctors and nurses are on hand to treat abnormal heart rhythms or other complications that may develop. Before the patient leaves the hospital, doctors may order an exercise stress test, coronary angiography, or other tests to evaluate whether the person should have angioplasty or bypass surgery.
(Coronary Bypass, Treatment Coronary Heart Disease)