Coronary Heart Disease: Treatment
|How is Coronary Heart Disease Treated?
The treatment for coronary heart disease (CHD) can involve lifestyle changes, drugs and medical procedures. The goal of treatment is either to:
1. Reduce coronary heart disease symptoms, such as chest pain.
Below, all three areas of treatment are discussed in more detail.
For those who have been diagnosed with CHD or who are at high risk of developing it, the following lifestyle changes may be recommended:
Following a heart healthy diet plan
Heart Healthy Diet Plan
Obesity in women: Obesity is one of the major risk factors for heart disease and increases a person's chances of stroke and a heart attack. Body mass index (BMI) is considered the best way to assess a person's weight (waist circumference and waist-hip-ratio are no longer recommended by the American Heart Association). A BMI of 25 to 30 is considered overweight, and people within this range have increased risks of heart and blood vessel disease. Obesity is defined at a BMI of 30 or over and these people are at higher risk of cardiovascular disease. Morbid or extreme obesity is defined as a BMI of 40 or over. Patients with CHD who are overweight will normally be asked to reduce their total body weight by 7 to 10 percent in the first year of treatment. This should help to reduce high cholesterol and high blood pressure.
Middle aged women in particular are more prone to heart attacks related to smoking than their male counterparts. In fact nearly half of all heart attacks in women can be attributed to smoking. The advice to quit smoking is relevant for all smokers, but particularly so to those already diagnosed with CHD. See the website: smokefree.gov for advice on quitting smoking. Also, what is considered middle aged?
Stress Reduction Techniques
Research shows that an emotionally upsetting experience is one of the most common triggers for a heart attack. Another contributory factor is that stress often drives people to drink more alcohol and to comfort eat on junk or fatty foods – all of which contribute to blocking arteries. Exercise is one great way to reduce stress levels as it increases circulation of the 'happy' hormones serotonin in the body and it increases ‘good’ cholesterol levels. Some people find meditation or yoga helps - if you don't have time to attend a class, there are plenty of excellent meditation or yoga DVD's available to purchase online. See also our home heart exercise program.
In addition to making lifestyle changes, CHD is also usually treated with either medication or surgery. Which approach is taken will depend on the patients age, their general health and the severity of their symptoms. Medication interventions include:
Cholesterol Lowering Therapy
Even if the patient has not yet developed CHD symptoms such as chest pain, a doctor may still recommend cholesterol lowering therapy to those with a history of high cholesterol. The Scandinavian Simvastatin Survival Study documented a 34 percent reduction in major coronary events (such as heart attack) and a 30 percent reduction in death rates among patients with CHD who were treated with aggressive cholesterol lowering drugs. The most common types of cholesterol lowering drugs include statins, nicotinic acid (niacin), resins, clofibrate and gemfibrozil. They work in different ways, some affect liver production, some work in the intestines and others interrupt the circulation of cholesterol in the bloodstream. Generally they all lower 'bad' LDL cholesterol and triglyceride levels and raise 'good' HDL cholesterol.
Nitrates or Vasodilators
Often prescribed to women who suffer angina attacks, vasodilators are also known as nitrate drugs (nitroglycerin tablets are a form of vasodilators). Common brands include isordil, natrecor, apresoline and nitrates and minoxidil. These medications relax the blood vessels so that more blood and oxygen can flow towards the heart. This also has the effect of reducing the heart's workload. Vasodilators come in the form of pills, chewable tables and topical creams.
Also known as beta-adrenergic blocking agents, common brands include Sectral, Tenormin, Kerlone, Zebeta, Cartrol, Ziac, Corgard, Betapace and Blocadren. Beta blockers medications work by slowing the heart rate which lowers blood pressure which in turn makes the heart beat more slowly. They are prescribed to patients with cardiac arrhythmias (abnormal heart rhythms) and angina. They are also given to patients after a heart attack to help avoid recurrence.
Calcium Channel Blockers
Also known as calcium antagonists, common brands of calcium channel blockers include norvasc, lotrel, cardizem, tiazac, nimotop, vascor, sular, calan, isoptin and verelan. These help prevent the arteries from going into temporary spasms and restricting blood flow. This is a common cause of chest pain in women.
If a heart attack or stroke has occurred, thrombolytic therapy medications can cause any remaining blood clots to dissolve, reducing the risk of a recurrence. For these drugs to work, they have to be administered within 12 hours of the heart attack, although ideally within 90 minutes of reaching the hospital. The most commonly prescribed therapy is tissue plasminogen activator (tPA). Additional medical intervention may also be necessary such as heart cath or angioplasty to help restore complete normal blood flow. See also, stroke in women.
Also known as blood thinners, common brands of anticoagulants include fragmin, lovenox, innohep, coumadin and orgaran. These medication reduce the clotting ability of the blood (stops it coagulating), so blood clots are less likely to form. They do NOT reduce existing clots. They are often prescribed to prevent a first stroke.
Aspirin therapy is the most commonly prescribed antiplatelet, others include clopidogrel, ticlopidine and dipyridamole. Antiplatelet medications help stop blood clots by preventing blood platelets from sticking together. They are often prescribed to patients who have had a heart attack, unstable angina or little strokes (TIA, transient ischemic attacks).
Angiotensin-Converting Enzyme (ACE). ACE inhibitors are used to expand blood vessels allowing blood to flow more freely and reduce work load on the heart. They do this by reducing levels of angiotensin II. Common brands include capoten, monopril, aceon, mavik, univasc and lotensin. They are often prescribed to patients with CHD symptoms including high blood pressure.
Angiotensin II Receptor Blockers (ARB), common brands include cozaar, avapro, diovan and atacand. Rather than lowering angiotensin II levels, these drugs work by blocking the chemical from having any effect on the heart and blood vessels. This keeps blood pressure stable.
Also known as water pills, brand names include diuril, lasix, midamor and lozol. Diuretics help the body to rid itself of excess fluid and sodium through urination. This helps reduce the heart's workload and decreases fluid build up in the lungs and other parts of the body (edema).
In many cases a surgical intervention is necessary to restore normal blood flow to blocked arteries. The two main types of medical intervention are coronary angioplasty and coronary bypass surgery.
Coronary AngioplastyAlso known as balloon angioplasty and percutaneous coronary intervention (PCI) this procedure (image) is the preferred method for treating patients who have had a heart attack. If a medical center does not have suitable facilities, thrombolytic therapy is used instead. During a heart angioplasty a thin tube with a deflated balloon at the end is threaded up into the affected coronary artery. The balloon is then inflated to widen the blocked area where blood flow has become restricted. Sometimes a stent is implanted which helps to keep the artery propped open to reduce the chance of another blockage. An angioplasty is considered a minimally invasive procedure because the body is not cut open. The procedure can last from 45 minutes to several hours, depending on the number of arteries damaged. It usually requires an overnight hospital stay. An angioplasty may be performed for several reasons and these are:
• Primarily to increase blood flow through blocked arteries.
• To decrease chest pain resulting from angina.
• To reduce the risk of a heart attack or stroke.
• To increase a person's ability to carry out physical activity.
• It can also be used to unblock the brain and neck arteries to prevent a stroke.
Coronary Bypass Surgery
Also known as CABG or 'cabbage', open heart surgery and coronary artery bypass graft (image). This is a serious procedure which is not undertaken lightly. A bypass treats blocked arteries by creating a new passage of blood around the blockage. A short piece of vein is taken from another part of the body, such as the thigh and is grafted onto the narrowed artery, creating an alternative route for blood flow. A patient may undergo 1, 2 or 3 bypass grafts depending on how many coronary arteries are blocked.
Surgery is normally an option if:• There is severe chest pain caused by narrowing of the arteries. Sometimes angioplasty will work, but for some types of blockages a bypass is necessary. Nearly 50 percent of those who undergo surgery remain pain free for 5 years.
• If the heart's main pump, the left ventricle is not functioning well.
• If the left main artery is severely blocked. This is the artery which supplies the left ventricle.
• If an angioplasty was performed and a stent inserted but it has not been successful.
• It may also be performed in emergency situation if the patient is not responding to medications.
Coronary bypass surgery does not cure the underlying disease which causes the blockages, that is atherosclerosis. In fact 4 out of every 5 coronary bypass surgery patients develop life-threatening blockages in the graft within 10 years. For this reason, lifestyle changes after surgery are important, as well as the taking of certain medications such as those to reduce cholesterol and the risk of developing blood clots. There is still however a debate as to whether open heart surgery prolongs life expectancy. Common complications include bleeding and heart rhythm irregularities (arrhythmia's). Less commonly, stroke, heart attack and liver failure. Women are twice as likely to die during the procedure or soon after than men. This may be because they tend to be 10 or 15 years older on average when they need it. For this reason they are less likely to be offered the surgery.
Know the Causes: Causes of Coronary Heart Disease.
Cardiac rehabilitation (rehab) is usually offered to patients who have had a heart attack, as well as those with angina, or who have undergone angioplasty or coronary bypass surgery. A rehab team consists of doctors, nurses, occupational therapists, dietitians and exercise specialists. The patient is normally given a treatment plan based on their abilities and personal needs, including a cardiac rehab exercise program. They are also offered advice on diet, and ways to reduce their risk of future problems by changing their current lifestyle.
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