CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE
Treatment
Coronary artery disease caused by atherosclerosis is treated with:
Lifestyle changes. These include weight loss in obese patients, quitting smoking, diet and medications to lower high chloresterol, regular exercise, and stress reduction techniques (medication, biofeedback, etc.).
Nitrates (including nitroglycerin). These medications widen blood vessels (vasodilaators). Nitrates widen the coronary arteries and increase the blood flow to the heart muscle. They also widen the body's veins, which lightens the heart's workload by temporarily decreasing the volume of blood returning to the heart for pumping.
Beta-blockers, such as atenolol (Tenormin) and metoprolol (Lopressor). These medications decreases the heart's workload by slowing the heart rate and reducing the force of heart muscle contractions, especially during exercise. People who have had a heart attack should stay on a beta-blocker for life to reduce the risk of a second heart attack.
Aspirin. Aspirin helps to prevent blood clots from forming inside narrowed coronary arteries. It can reduce the risk of heart attack in people who already have coronary artery disease. Doctors often advise people older than 50 to take a low dose of aspirin every day to help prevent a heart attack.
Cholestoerol-lowering medications. Statins—such as lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol) and atorvastatin (Lipitor)-have had the greatest impact on improving the risk of a heart attack and death in people with coronary artery disease and those at risk of coronary artery disease. Statins lower LDL cholesterol and may raise HDL cholesterol slightly. Taking a statin regularly also helps to prevent plaque from tearing or breaking, which decreases the chance of a heart attack or worsening of angina. Niacin lowers LDL cholesterol, raises HDL cholesterol, and also lowers triglyceride levels. Medications called fibrates, such as gemfibrozil (Lopid), are used primarily in people with high triglyceride levels. Ezetimibe (Zetia) works with the intestine the decrease the absorption of cholesterol from food.
Calcium channel blockers, such as long-acting nifedipine (Adalat, Procardia) verapamil (Calan, Isoptin), diltazem (Cardizem), amlodipine (Norvasc). These medications may help to decrease the frequency of chest pain iin patients with angina.
If your stable angina limits you physically because of chest pain, your doctor likely will advise you to have a coronary artery angiography (cardiac catheterization) to look for significant blockages. A heart specialist (cardiologist) also may do this test to diagnose coronary artery disease when other tests are not conclusive, in an emergency when a person is having a heart attack, and in some people with newly diagnosed congestive heart failure.
When one or more significant blockages are found, the specialist will determine if the blockage(s) can be opened with a procedure called ballon angioplasty, also called percutaneous transluminal coronary angioplasty or PTCA, in balloon angionplasty, a catheter is inserted into an artery in the groin or forearm and then is threaded through the circulatory system into the blocked coronary artery. Once inside the coronary artery, a small balloon at the catheter tip is inflated briefly to open the narrowed blood vessel. Usually, balloon inflation is followed by the placement of a stent, a wire mesh that expands with the balloon. The wire mesh remains inside the artery to keep it open. The balloon is deflated and the catheter is removed.
If the blockages cannot be opened with balloon angioplasty, the cardiologist will likely suggest coronary artery bypass surgery (CABG). CABG involves grafting one or more blood vessels into the coronary arteries to bypass the narrowed or blocked areas. The blood vessels to be grafted can be taken from an artery inside the chest, an artery in the arm, and from a long vein in the leg.
The goal of treating heart attacks or sudden worsening of angina is to restore blood flow rapidly to the section of heart muscle no longer getting blood flow. Patients immediately received medication to relieve pain. They also receive a beta-blocker to slow the heart rate and decrease the work of the heart and aspirin combined with other medications to dissolve or inhibit blood clotting. When possible, patients are transferred to a cardiac catheterization laboratory for immediate angiography and balloon angioplasty of the most significant blockage. In some people with coronary artery disease, other symptoms or complications will require treatment with additional therapies. For example, medication may be needed to treat cardiac arrhythmias (abnormal heart rhythm), low blood pressure or heart failure.
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