Treatment
Options
Medication
Doctors use drugs to prevent and relieve the symptoms of coronary artery disease. Some drugs can decrease the level of blood cholesterol while others can relieve pain caused by narrowing of the arteries. Here are just a few:
Anticoagulants are drugs that prevent blood from clotting. These drugs do not dissolve existing clots, they only prevent an existing clot from enlarging or more clots from forming.
Nitroglycerin is a vasodilator, a drug that causes arteries to relax and expand slightly. This action permits more blood to reach the heart muscle and relieves attacks of angina and spasms of the coronary arteries.
Beta Blockers lighten the heart's workload by slowing the heart rate and lessening the force of the heart muscle contraction.
Calcium Channel Blockers work like Beta Blockers in reducing the frequency and severity of angina.
Aspirin Therapy Acetylsalicylic acid, or good old aspirin, has turned into the most surprising and beneficial drugs in fighting and preventing heart disease. Aspirin thins the blood and is thought to inhibit the formation of blood clots that could block narrowed arteries. Side effects are small, but can include irritation of the stomach lining and slower clotting of blood in injuries. However, the benefits of this inexpensive over-the-counter medicine far outweigh the risks. The most beneficial dosage for people who have heart disease is 325mg per day, or one tablet. Buffered or coated aspirin can reduce the chance for stomach irritation. Check with your physician, however, before taking aspirin daily.
Surgical Options
Balloon angioplasty involves inserting a tiny tube called a catheter with a tiny balloon on the end of it into an artery in the arm or groin that leads up to the heart. The doctor expands the balloon at the narrowing in the heart artery. The balloon squeezes the plaque out along the sides of the artery making the opening bigger.
A similar procedure uses a miniature surgical steel wire mesh tube, called a stint, instead of a balloon. Using a catheter, the physician inserts this tube, which is thin when elongated, into the artery at the point of the blockage. The doctor then shortens the tube's length. As it shortens, the tube's diameter increases and it expands the opening through the plaque so that blood can now pass through. This mesh tube stays in the artery.
PTCRA (Percutaneous transluminal coronary rotational atherectomy) also involves inserting a catheter into the blocked or narrowed heart arteries. Instead of a balloon on the end, it has a small rotary blade that cuts the plaque away from the sides of the blocked artery.
In coronary artery bypass surgery, the surgeon grafts a healthy section of an artery taken from the chest muscle (internal mammary graft) or a vein from the leg (saphenous vein graft) onto the heart to carry blood around the blocked artery or arteries to the heart muscle.
The most common surgical method, called open heart surgery, is to open the chest cavity, expose the heart and attach the graft. This method has been perfected so much that it is now commonplace. Patients most often take several weeks to recover from this surgery.
Some medical centers in the United States are experimenting with a less invasive method of doing single artery bypasses. In this method, the surgeon inserts very small instruments and a miniature video camera, called a laparoscope, through small incisions in the patient's chest and abdomen. The tiny instruments are then used to attach the "bypass" artery or vein to the heart. Recovery time is usually less in this type of surgery than in the more conventional method of open heart surgery. This surgical method holds the most promise for the future of heart surgery due to the fewer number of days in the hospital and faster total recovery time.
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