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Coronary artery disease (CAD)
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Coronary artery disease

Diseases & Conditions A-Z

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HEART & BLOOD

Heart Disease

HEART & BLOOD

Heart Attack & Failure

From MayoClinic.com

Treatment

If your doctor finds that you have coronary artery disease, several treatment approaches are possible, depending on the seriousness of the disease. Many people are able to manage coronary artery disease with lifestyle changes and medications. Other people with severe coronary artery disease may need coronary angioplasty or surgery.

Lifestyle changes

Although great advances have been made in treating coronary artery disease, changing your habits remains the single most effective way to stop the disease from progressing. Here are the most beneficial changes you can make:

  • Don't smoke. Smoking is a major risk factor for coronary artery disease. Quitting smoking dramatically lowers your risk of a first or second heart attack.

  • Improve your diet. If you know that you have coronary artery disease, changing your diet to one low in fat — especially saturated fat — and cholesterol will help reduce high blood cholesterol, a primary cause of atherosclerosis. It's important to keep your cholesterol low after a heart attack to help lower your risk of having another one. Eating less fat should also help you lose weight. If you're overweight, losing weight can help you further lower blood cholesterol. Eating a diet rich in fruits and vegetables and having at least one to two servings of fish a week also can reduce your risk of a heart attack.

  • Exercise regularly. Even moderate amounts of physical activity — 30 minutes a day — can lower your risk of death from coronary artery disease. However, people with severe coronary artery disease may need to restrict their exercise somewhat. If you have coronary artery disease, check with your doctor to find out what kinds of exercise are best for you.

Medications

In addition to lifestyle changes, your doctor may recommend drug therapy to treat coronary artery disease. Medications to prevent or treat coronary artery disease include:

  • Cholesterol-lowering drugs. Cholesterol is a large part of the deposits that can narrow heart arteries. A high level of cholesterol in your blood increases your risk of coronary artery disease. Cholesterol-lowering drugs, also called lipid-lowering drugs, help lower the level of "bad" cholesterol in your blood while raising the level of "good" cholesterol. One type of cholesterol, HDL, actually helps protect against coronary artery disease. Examples of cholesterol-lowering drugs include statins, niacin, fibrates and bile acid sequestrants.

  • Aspirin. Aspirin, as well as other blood thinners, can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries.

  • Beta blockers. These drugs slow your heart rate and decrease blood pressure, which in turn decreases your heart's demand for oxygen. Beta blockers also have been shown to reduce the risk of death in people during and after a heart attack. In addition, they're beneficial for people with a weakened heart muscle and congestive heart failure.

  • Nitroglycerin. Nitroglycerin tablets, spray and patches can control chest pain (angina) by both opening up your coronary arteries and reducing your heart's demand for blood.

  • Calcium channel blockers. These medications cause the muscles that surround your coronary arteries to relax and the vessels to open more, increasing blood flow to your heart. They also control high blood pressure.

  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs allow blood to flow from your heart more easily, decreasing your heart's workload. ACE inhibitors are the mainstay treatment for congestive heart failure, which can be a complication of coronary artery disease.

  • Other drugs that lower blood pressure, such as diuretics. These medications help open up your blood vessels, including those to your heart, decreasing your heart's workload.

You may need to take drugs for your heart indefinitely, or you may take medications temporarily until a risk factor for coronary artery disease is better under control.

Procedures to restore and improve blood flow

Types of procedures to improve coronary blood flow (revascularization) include:

  • Percutaneous coronary intervention. Also known as angioplasty or stent placement, this is a common treatment for severe blockage of the coronary arteries. Only a small cut is required in your skin to put the catheter into the blood vessel. In this procedure, a doctor inserts a catheter with a small balloon at the tip into an artery in your groin or arm. The catheter is then threaded to the region of a coronary artery that's narrowed. When the catheter reaches the blockage, the balloon is inflated to widen the artery and improve blood flow. Often small wire tubes (stents) are placed into the area where the blockage occurred to keep the artery from narrowing again. However, drug-eluting stents are not appropriate or necessary in all situations, and long-term results are still pending. If percutaneous coronary intervention doesn't widen the artery or if complications occur, you may need bypass surgery.

  • Coronary bypass surgery. This requires open heart surgery. It's a procedure used to create a route for blood to go around a blocked stretch of a coronary artery. A blood vessel, usually taken from your leg or chest, is grafted directly onto a narrowed artery, bypassing the blocked area. If more than one artery is blocked, a bypass can be done on each. The blood can then go around the obstruction to supply your heart with enough blood to relieve chest pain.

  • Atherectomy. In this procedure, a catheter is inserted into an artery. The catheter is equipped with a diamond-shaped device that rotates up to 200,000 times a minute to shave plaques off your artery walls.

Research into new ways to treat coronary artery disease is yielding possibilities. Here are some areas of current research:

  • Radiation (brachytherapy) following coronary angioplasty. The majority of people who undergo coronary angioplasty for coronary artery disease receive small wire tubes (stents) to hold the arteries open longer. Generally, stents work well at keeping arteries open. However, in some people, blockage reoccurs following coronary angioplasty. Researchers are studying whether treating narrowed coronary arteries with radiation at the time of angioplasty prevents new blockages from forming.

  • Gene therapy. Scientists are using genes that produce growth factor proteins to stimulate growth of new blood vessels (angiogenesis) and restore blood flow to the heart. They're studying delivery of the genes and proteins to the heart via a direct injection into the heart through a small incision or by a catheter-delivery technique.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/14/08 11:08 PM