How is coronary artery disease treated?

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Dr. Sameer A. Sayeed, MD
Cardiologist (Heart Specialist)

Coronary artery disease can be treated in several fashions. The easiest way is with medications like aspirin that prevent blood clots, and medications that lower blood pressure and cholesterol and help prevent further damage to the coronary arteries and coronary artery disease. Some cholesterol lowering medications, known as statins, may help reverse coronary artery disease to some degree by remodeling the vessel and its blockages or cholesterol plaques. Avoiding smoking can also prevent further coronary artery disease. Low fat, low cholesterol, low sodium diet and aerobic exercise can also help to treat coronary artery disease.

When coronary artery disease is much more severe and there are blockages in the arteries causing symptoms or a heart attack, the coronary artery disease can be treated with inflatable balloons that are inserted into the artery and help open up or break up or cut through blockages. There are also rotating devices that help break through blockages. Stents, whether drug coated or not, are also used to open up blockages and treat coronary artery disease and can help delay the redevelopment of blockages.

When coronary artery disease is extensive and involves a lot of coronary arteries or is not amenable to treatment with medication, balloons or stents, it can be treated with coronary artery bypass grafting or open heart surgery where conduits such as veins from the legs or arteries from the chest are used to bypass diseased, blocked coronary arteries and restore adequate blood flow to the heart.

Coronary artery disease can be treated with medications alone in many people. The most common procedures to treat coronary artery disease include coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). Both treatment options will restore blood flow to the heart, but there is no one treatment guaranteed to be effective for all cases of coronary artery disease. In general, both CABG and PCI are designed to make people with coronary artery disease live longer by decreasing the likelihood of dying from a heart attack (myocardial infarction). These procedures are also very effective at improving the symptoms of coronary artery disease, including chest pain and shortness of breath.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.
Dr. Mehrdad Ariani, MD
Cardiologist (Heart Specialist)

First is to treat the co-morbid conditions leading to CAD. Of most importance, are:

  • Smoking Cessation
  • Control of diabetes
  • Blood pressure control (by Diet, weight loss or medication), Decreasing and improving on cholesterol levels and composition (good HDL cholesterol vs. Bad LDL cholesterol) again by diet or drugs
  • Healthy life style   
Then there are invasive strategies namely Angioplasty and stent placement and ultimately for severe cases "Open Heart Surgery".

 

 

Dr. Nassir A. Azimi, MD
Interventional Cardiologist

The best treatment for coronary artery disease is preventative efforts.  Excercise such as walking 5 days a week 30 minutes at a time, diet, managing cholesterol and blood pressure and avoiding bad habits such as smoking are essential.  Once the disease manfiests as either angina or heart attack these measures become paramount.

Medications such as nitroglycerin are used for angina.  Aspirin and drugs such as Plavix/Effient/Brillinta are used to prevent clotting of the arteries.  Statin medications are used to reduce heart attacks and progression of disease.  Beta-blockers to reduce angina and sudden death from arrhythmias.  ACE inhibitors are used for reduction in atherosclerotic progression.

Additional agents such as Ranexa are to reduce angina.

Various medications constitute the first-line treatment of coronary artery disease. These include:

  • Beta-blocking drugs: These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby reducing the oxygen demand of the heart. Studies have found that these drugs also can reduce the chances of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart attack and continued for two years.
  • Calcium-channel-blocking drugs: All muscles need varying amounts of calcium in order to contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery walls, spasms can be prevented. Some calcium-channel-blocking drugs also decrease the workload of the heart and some lower the heart rate as well.
  • Nitrates: Nitroglycerin may be prescribed to both treat and prevent attacks of angina.
Dr. Adam M. Levine, DO
Interventional Cardiologist

Treatment for coronary artery disease usually includes medication, such as a beta blocker to reduce the strain on the heart, and medicine to reduce blood pressure and cholesterol. Aspirin therapy is recommended to reduce the risk of heart attack. If the person is having a lot of symptoms such as chest discomfort or severe fatigue, then heart catheterization (where x-ray and contrast dye are used to look at the arteries that supply blood to the heart) would be done to assess the severity of coronary artery disease and determine what further therapy would be needed.

Dr. John F. Canales, MD
Interventional Cardiologist
Coronary artery disease is treated through prevention. Watch John Canales, MD, with Northeast Methodist Hospital, talk about the importance of eating well and regular exercise.
Dr. J J. Marshall, MD
Cardiologist (Heart Specialist)

Over the last 30 years, there has been a revolution in the treatment of coronary artery disease (CAD) - and scientists make new discoveries every day. By following your doctor's treatment plan, you may be able to prevent your heart disease from getting any worse and possibly even reverse some of the plaque build-up that is a cause of heart attacks. You can markedly reduce your risk for a heart attack and look forward to living a long and active life.

Medical therapy. Several types of medications may be used to treat CAD, depending on your health profile and symptoms, including the following:

  • Cholesterol-lowering medicines (called statins) and other medications to slow or stop plaque build-up in your arteries
  • Beta blockers if you have high blood pressure or angina, or have had a heart attack
  • Aspirin to ward off blood clots that could cause a heart attack 
  • Angiotensin-converting-enzyme (ACE) inhibitors to treat high blood pressure and prevent additional heart attacks 
  • Calcium-channel blockers to reduce blood pressure and at times slow the heart’s rate
  • Nitroglycerin to relieve angina (chest pain)
Catheter-based therapies. If a blockage or plaque is severe enough, your doctor may recommend treating it with a minimally invasive procedure, such as angioplasty and stenting. With this form of treatment, an interventional cardiologist expands the obstructed artery by positioning a thin flexible tube, called a catheter inside, right where the artery is narrowed. Then a small balloon mounted on the catheter's tip is inflated to create cracks in the plaque and stretch the artery. Next, an expandable mesh metal tube (a stent) is placed inside the artery to act as scaffolding to hold the artery open.

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Heart and Circulatory System

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.