Treatment for Heart Disease
Treatment for heart disease depends on the severity of symptoms and the extent of the condition. Treatment options include lifestyle changes, medication, and surgery (e.g., angioplasty, coronary artery bypass).
In mild cases, lifestyle changes may help to control the underlying cause of heart disease (e.g., high blood pressure, diabetes, high cholesterol).
These changes may include the following:
- Diet modifications
- Regular exercise
- Smoking cessation
- Weight loss
Diet modifications can help patients maintain an appropriate weight for their frame and build. Physicians recommend eating a well-balanced, low-fat, low-cholesterol diet that includes several servings of fruits and vegetables daily. Vitamin supplements that may help prevent heart disease may also be recommended.
Regular exercise is important. Short, frequent sessions of exercise are preferable to a complete sedentary lifestyle. Before beginning any exercise program, please consult with your physician.
Medications that may be used to treat heart disease include the following:
- HMG-CoA reductase inhibitors (statins) to lower cholesterol (e.g., Lipitor, Lescol, Crestor, Zocor)
- Blood pressure medications (e.g., ACE inhibitors, angiotensin-receptor blockers [ARBs], beta blockers, calcium channel blockers, diuretics)
- Medications that reduce the risk for blood clots (e.g., antiplatelets [aspirin, ticlopidine, clopidogrel])
- Nitrates (e.g., nitroglycerin) to dilate the coronary arteries and improve blood flow to the heart
Coronary angioplasty, also called percutaneous transluminal coronary angioplasty (PTCA), or angioplasty, is an invasive procedure performed to reduce or eliminate blockages in coronary arteries. The goal of PTCA is to restore blood flow to blood-deprived heart tissue, reduce the need for medication, and eliminate or reduce the number of episodes of angina (chest pain).
Opening a blockage, or a plaque, in a coronary artery typically involves the use of an angioplasty balloon. When the blockage is calcified or so dense that a balloon cannot be placed, other devices are used. Plaque can be cut out, ablated with a laser, or bored out using a surgical drill bit. Often, a stent (small tube) is implanted after angioplasty to keep the artery open and prevent regrowth of plaque (restenosis).
The arteries are accessed through a needle puncture made in the groin (femoral artery) or arm (brachial artery). In most cases, the femoral artery is used.
More than one blockage may be treated during a single session, depending on the location of the blockages and the patient's condition. The procedure can take 30 minutes to several hours, depending on the number of blockages being treated.
Coronary atherectomy (also called "rotorooter") is another procedure that can be used to remove plaque and open up arteries. Atherectomy can be performed by conventional surgical incision or through a catheter inserted into the artery (similar to angioplasty). Balloon angioplasty or stent implantation may be performed following atherectomy.
Coronary brachytherapy is a relatively new treatment that may be used in patients who develop restenosis after undergoing coronary stenting. It involves delivering radiation to the coronary arteries. The long-term effects of this procedure are unknown. The use of coronary brachytherapy as a first-line treatment is being studied.
Coronary artery bypass is performed to reroute blood flow around blocked coronary arteries. In this procedure, the surgeon uses a piece of artificial vessel or removes a segment of a healthy blood vessel from another part of the body (e.g., a vein in the leg) and uses the segment to create a new path to the heart (called a graft). One or more grafts may be performed, depending on the number of blockages.
In some cases, patients are placed on a heart-lung machine (pump oxygenator) during the surgery. After coronary artery bypass, the patient usually is hospitalized for at least 3 to 5 days. Side effects include loss of appetite, constipation, fatigue, soreness, and swelling in the area from which the healthy blood vessel was removed.
Full recovery may take months, and during this time, most patients must participate in a physician-monitored cardiac rehabilitation program.
Complications from coronary artery bypass include the following:
- Arrhythmia (abnormal heart rhythm)
- Damage to the aorta (the major artery in the body)
- Embolism (blood vessel obstruction by a foreign substance [e.g., air] or a blood clot)
- Heart attack