Coronary Artery Disease Treatment
In addition to their family doctor, people with heart disease are often treated by a cardiology specialist. Cardiology is the medical discipline that specializes in heart disease. Cardiology specialists include:
Cardioloists have special training and skills in diagnosing, treating, and preventing diseases of the heart and blood vessels in adults.
- Pediatric cardiologists
Pediatric cardiologists work with infants, children, and teenagers.
- Cardiac surgeons
Cardiac surgeons have special training and skills to operate on the heart, blood vessels, and lungs.
Electrophysiologists are cardiologists who specialize in arrhythmias.
Additional members of the healthcare team may include:
- Counselors or psychologists
- Exercise specialists
- Family doctor
- Occupational therapists
- Physical therapists
Common coronary artery disease treatments include:
Several lifestyle changes can help people lower their heart disease risk factors. When lifestyle changes aren't sufficient, medications, and sometimes procedures and surgery may be required.
Eating a Healthy DietThe following heart-healthy dietary modifications are recommended by the American Heart Association and the National Heart, Lung, and Blood Institute:
- Total fat
- Total fat should be no more than 25 to 35% of the daily calories.
- Foods containing monounsaturated fats and polyunsaturated fats are a better choice than foods containing saturated fats and trans fatty acids.
- Saturated fat
- Saturated fat should be less than 7% of the total daily calories.
- Foods containing saturated fats include certain vegetable oils (coconut oil, cottonseed oil, and palm oil), dairy products (butter and cheese), and meat.
- Trans fatty acids
- Trans fatty acids (trans fat) should be less than 1% of the total daily calories.
- Foods that list "hydrogenated oils" or "partially hydrogenated oils" on the label contain trans fatty acids.
- Monosaturated fats
- Monosaturated fats should be less than 20% of the total daily calories.
- Foods containing monosaturated fats include nuts, avocados, and certain vegetable oils (canola oil, flaxseed oil, olive oil, and peanut oil).
- Polyunsaturated fats
- Polyunsaturated fats should be less than 10% of the total daily calories.
- Foods containing polyunsaturated fat include certain vegetable oils (corn oil, safflower oil, soybean oil), fatty fish (bass, halibut, herring, mackerel, salmon, sardines, trout, and tuna), and soybeans.
- Total cholesterol
- Total cholesterol should be less than 200 milligrams per day
- Total carbohydrates
- To lower triglyceride levels, total carbohydrate consumption should be less than 50% of the total daily calories. Simple sugars (such as sucrose) and alcohol should be avoided.
- Soluble plant fiber
- Soluble plant fiber should be increased 10 to 25 grams per day
- Foods containing soluble plant fiber include leafy vegetables, legumes, whole grains, and whole fruits.
- Salt (sodium chloride) can increase a person's blood pressure. Moreover, salt-sensitive people have a heightened blood pressure response to salt.
- People should check all labels of packaged food carefully for sodium content, replace salt with salt substitutes and herbs, and increase dietary potassium (such as fruits and vegetables).
- Heart failure may cause people to gain weight suddenly due to a fluid build up in their bodies.
- People should limit the amount of fluids they drink, weigh themselves daily, and notify their doctor immediately if they gain weight suddenly.
- Healthy foods
- Fish, lean meats, and skinless chicken or turkey
- Fruits and vegetables
- Legumes (dry peas or beans)
- Low-fat dairy
- Whole grains
- FDA-approved low-calorie sweeteners
- Saccharin (Sweet N Low, Sugar Twin)
- Aspartame (NutraSweet, Equal)
- Acesulfame potassium (Sweet One, Swiss Sweet, Sunett)
- Sucralose (SPLENDA)
- In 2007, the American Heart Association and the American College of Sports Medicine issued new exercise guidelines. Their new recommendation is for healthy adults to engage in moderate-intensity aerobic physical activity for at least 30 minutes five days each week, or vigorous-intensity aerobic exercise for at least 20 minutes three days a week. In addition, the guidelines add that exercise above the recommended minimum amounts provides even greater health benefits.
- Moderate-intensity aerobic activity is any exercise that noticeably accelerates the heart rate, such as a brisk walk or light jogging.
- Vigorous-intensity exercise is any exercise that causes rapid breathing and a substantial increase in heart rate, such as jogging.
- People with angina should take rest breaks if exercise causes their angina.
- It's important for people to discuss all exercise modifications in advance with their healthcare provider.
- People should eat sufficient calories to maintain a healthy weight as determined by their healthcare provider.
- A healthcare provider can also recommend an appropriate diet and physical activity program for people who are overweight.
- The American Heart Association recommends using waist circumference and body mass index (BMI) to estimate body fat.
- A high-risk waistline is 35 inches or higher for women and 40 inches or higher for men.
- To calculate BMI, multiply weight in pounds by 703, divide by height in inches, then divide again by height in inches.
- Overweight is defined as a BMI of 25.0 to less than 30.0, obesity is defined as a BMI of 30.0 or greater, and extreme obesity is defined as a BMI of 40 or greater.
- Note that although BMI is useful for most people, it is not precise for the elderly, pregnant women, or very muscular athletes.
Measuring blood cholesterol at homeSome people use home kits to test their blood cholesterol levels at home. Simple kits only test total cholesterol or LDL cholesterol levels. More sophisticated kits provide complete lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides).
Cholesterol kits require people to prick a finger, put a drop of blood on a treated paper, and wait for the test results. The test results are obtained by:
- Comparing the color of the treated paper to a chart.
- Reading the test results on the display screen of an electronic device.
- Or, mailing the test strips to a certified laboratory.
A doctor is the best judge of treatment decisions based on cholesterol test results.
Measuring blood pressure at homeHome blood pressure monitors help people check that their blood pressure medication is working and warn them if their blood pressure is getting too high. The devices are available without prescription.
Measuring blood sugar levels at homePeople with diabetes can help manage their condition by testing their blood sugar levels regularly. A doctor typically recommends how often people should test their blood sugar, and sets the target fasting and before-meal blood sugar ranges. People should keep a record of their blood sugar readings and bring the record to all doctor visits.
Reducing alcohol consumption
- Alcohol has been shown to raise blood pressure in some people. Moreover, regular or excessive alcohol use may raise LDL cholesterol and triglyceride levels.
- Men should limit their alcohol to no more than two alcoholic beverages a day and women should limit their alcohol to no more than one alcoholic beverage a day.
- Because alcohol is high in calories and low in nutrients, it should be avoided by people who are trying to lose weight.
- Emotional stress causes a temporary rise in blood pressure and may cause susceptible people to develop high blood pressure.
- Some people develop angina due to emotional stress.
- People should get sufficient rest and sleep, exercise regularly, avoid stressful situations, and try using a relaxation technique (such as deep breathing and self-hypnosis).
- According to the Centers for Disease Control and Prevention (CDC):
- Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers.
- Cigarette smoking approximately doubles a person’s risk of having a stroke.
- According to the American Heart Association:
- The health benefits of smoking cessation start almost immediately.
- Within a few years of quitting, a person's risk of coronary artery disease and stroke are similar to non-smokers.
Support groupsHeart disease support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.
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Medications are used when lifestyle changes don't sufficiently lower a person's heart disease risk factors or the coronary artery disease symptoms worsen. Some people with coronary artery disease may require hospitalization. During their hospital stay, they may be given oxygen and intravenous medications. Additional procedures or surgeries may be performed to improve the blood flow to diseased coronary arteries.
The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. A doctor should be notified if any severe reactions occur. It's important not to stop taking medications without notifying a doctor in advance.
People should ask their doctor or pharmacist in advance for possible drug side effects or interactions. They should also inform their doctor or pharmacist of all prescription and over-the-counter medicines they are taking.
Coronary artery disease medications include:
Cholesterol-lowering medicationsCholesterol is a type of lipid (organic fats and oils) that is found in every cell of the body and is transported throughout the body by the bloodstream. People develop high blood cholesterol if the body produces and consumes more cholesterol than it needs. Some people require a combination of lifestyle changes and medications to control their cholesterol and triglyceride levels. They work closely with their doctor to identify which drug or drugs work best for them. Examples include:
StatinsStatin drugs (HMG-CoA reductase inhibitors) inhibit the enzyme HMG-CoA reductase, which the liver needs to make cholesterol. Statins lower LDL cholesterol levels in the blood. Examples include:
Bile acid sequestrantsBile acid sequestrants (resins) bind the bile acids in the intestine. The bile acids are excreted, which reduces the supply of bile acids to the liver. The liver uses cholesterol to produce additional bile acids, thus lowering the level of LDL cholesterol in the blood. Examples include:
NiacinNiacin (nicotinic acid, vitamin B3) reduces LDL cholesterol, increases HDL cholesterol, and reduces triglyceride levels in the blood. It works by altering the production of blood fats in the liver. Prescription niacin is preferred to the dietary supplement niacin. Dietary supplements are not regulated by the Food and Drug Administration (FDA), and may contain variable amounts of niacin and cause serious side effects. Examples include:
FibratesFibrates are used to reduce triglyceride and increase HDL cholesterol levels in the blood. Because they are not very successful in lowering LDL cholesterol, they are often prescribed in combination with statins. Examples include:
Antiplatelet medicationsAntiplatelet medications reduce the risk of blood clots inside blood vessels. They help prevent new clots from forming and existing clots from getting larger. Examples include:
Nitrates (vasodilators) cause blood vessel walls to relax, which dilates (widens) the blood vessels and increases the blood supply to the heart. Nitrates are prescribed to relieve chest pain. If the chest pain doesn't go away after taking nitrates as prescribed, people should call 911 or their local emergency number. Examples include:
Blood pressure medicationsSeveral types of high blood pressure medications help lower a person's heart rate and the heart's oxygen use, which reduces the strain on the heart and improves the blood supply to the heart. Additional high blood pressure medications (antihypertensives) are prescribed for people with high blood pressure when lifestyle changes, such as a healthy diet and physical activity, are unable to lower their blood pressure to normal levels.
Angiotensin-converting enzyme (ACE) inhibitorsAngiotensin-converting enzyme (ACE) inhibitors work by preventing the body from converting angiotensin I to angiotensin II, which is a natural hormone that causes blood vessels to constrict (narrow). ACE inhibitors cause the blood vessels to dilate (widen), which lowers blood pressure, improves blood flow to the heart, and reduces the strain on the heart. Examples include:
Beta-blockers Beta-blockers alter the response of the heart muscle's beta receptors to nervous system impulses. This decreases the force and rate of the heart's contractions, which lowers blood pressure and reduces the heart's need for oxygen. Examples include:
Calcium channel blockersBlood vessels and heart muscle cells need calcium to contract. By blocking the action of calcium on the blood vessels, calcium channel blockers dilate (widen) the blood vessels, which increases the supply of oxygen-rich blood to the heart and decreases blood pressure. By blocking the action of calcium on the heart muscle cells, they also relax the heart muscle, which slows the rate of heart contractions. Examples include:
Additional high blood pressure medicationsThere are several classes of high blood pressure medications. People are often prescribed two or more medications from different classes of drugs. Different medications are often tried until the appropriate regimen is identified.
Diuretics (water pills) lower blood pressure. They also rid the body of excess fluids and sodium, which helps reduce swelling (edema) in the legs, ankles, and feet. Diuretics are often the first medication used to reduce high blood pressure. They work by helping the kidneys remove excess fluids and sodium from the body. If a person's blood pressure remains above normal, diuretics are used in addition to other medications, sometimes in a combination pill. Examples include:
Angiotensin II receptor blockers (or inhibitors)
Angiotensin II receptor blockers (ARBs) are a newer medication that prevents angiotensin II from tightening blood vessels. The blood vessels relax, which lowers blood pressure, improves blood flow to the heart, and reduces the strain on the heart. ARBs provide an alternative medication for people who are unable to tolerate ACE inhibitors. Examples include:
Direct renin inhibitors
Early in 2007 the FDA approved the first direct renin inhibitor for the treatment of high blood pressure. Direct renin inhibitors lower blood pressure by inhibiting renin, which is a kidney enzyme associated with the regulation of blood pressure. The approved drug is:
Tekturna may be combined with hydrochlorothiazide (a diuretic) to reduce blood pressure levels even further.
Beta-blocker + diuretic
ACE inhibitor + diuretic
Angiotensin II receptor antagonist + diuretic
ACE inihibitor + calcium channel blocker
Alpha blockers lower blood pressure by reducing nerve impulses that constrict blood vessels and slow the heartbeat. Examples include:
Alpha-beta blockers lower blood pressure by both reducing nerve impulses to the blood vessels (alpha blocker component) and slowing the heartbeat (beta-blocker component). Examples include:
Central-acting agents (central alpha agonists)
Central-acting agents lower blood pressure by preventing signals to the nervous system that increase heart rate and narrow blood vessels. Examples include:
Vasodilators lower blood pressure by preventing the blood vessel muscles from constricting (narrowing). Examples include:
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Procedures and surgery
Medical procedures and surgery are used if lifestyle changes and medications have not:
- Reduced a person's heart disease risk factors.
- Improved a person's heart disease symptoms or the symptoms are getting worse.
Coronary artery disease procedures and surgery include:
Angioplasty and stentingCoronary angioplasty (balloon angioplasty or percutaneous transluminal coronary angioplasty) improves blood flow to the heart by opening narrowed or blocked coronary arteries. A catheter (flexible tube) is inserted in the body and advanced to the blockage. A balloon at the tip of the catheter is then inflated to widen the artery. Laser angioplasty uses a laser tip to vaporize the plaque.
A stent (tube) is often placed in the artery after angioplasty to provide structural support for the artery. One problem with bare-metal stents is that scar tissue may grow over the stent, causing the artery to re-narrow. Clots may also form on the artery wall, requiring people to take anti-clotting medication for at least a year afterwards. Drug-eluting stents (drug-coated stents) release drugs designed to prevent the re-narrowing of the artery. Studies indicate that drug-eluting stents are more effective than bare-metal stents in the short term, although the long-term results are unknown.
AtherectomyCoronary atherectomy improves blood flow to the heart by opening narrow or blocked coronary arteries. A catheter is inserted in the body and advanced to the blockage. A rotating shaver on the end of the catheter then shaves or cuts away the plaque. The procedure is often combined with angioplasty and stenting.
Coronary artery bypass surgeryCoronary artery bypass surgery (coronary artery bypass grafting or CABG) improves blood flow to the heart by detouring blood around a blocked coronary artery. A heart-lung bypass machine is used to oxygenate and circulate the blood during the surgery.
A healthy artery or vein from another part of the body is grafted to the blocked coronary artery. The blood flow is then rerouted to avoid the blockage. Bypass surgery is used for blockages that can't be widened with angioplasty.
Minimally invasive heart surgeryMinimally invasive heart surgery restores blood flow to a diseased heart without the risk of stopping the heart or using a heart-lung bypass machine. Instruments are passed through small incisions in a person's chest. The surgeon then grafts a healthy artery or vein to a blocked coronary artery while viewing the operation on video monitors.
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Cardiac rehabilitationCardiac rehabilitation (rehab) is often recommended for people with heart disease, especially after a heart procedure, heart surgery, or heart attack. Cardiac rehab programs are designed to help people improve their health and physical fitness, while reducing their symptoms and heart disease risk factors. A medical evaluation is used to create a personalized rehab program based on a person's individual abilities, interests, and needs.
Education, counseling, and training help people manage their heart condition, reduce their risk of future heart problems, and maintain a more active lifestyle when possible. People learn how to:
- Cope with depression and stress.
- Develop a healthy eating plan, exercise plan, and maintain a healthy weight.
- Lower their blood pressure and cholesterol levels.
- Resume some, if not all, of their normal activities.
- Return to work if possible.
- Stop smoking.
A personalized exercise plan helps people:
- Exercise safely.
- Gradually improve their strength, stamina, and exercise level.
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Complementary and Alternative Medicine
Alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Complementary medicine combines traditional and alternative treatments.
The following nontraditional therapies may help people with heart disease. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them.
Artichoke Leaf ExtractArtichoke leaf extract is made from the lower leaves of the artichoke plant Studies indicate that artichoke leaf extract may lower LDL cholesterol levels.
BiofeedbackBiofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns. Biofeedback techniques are able to produce a modest reduction in blood pressure.
Coenzyme Q10Coenzyme Q10 (CoQ10 or ubiquinone) is a naturally occurring anti-oxidant compound and is used for energy production within cells. CoQ10 may help lower blood pressure.
FolateFolate is a B vitamin that has been shown to reduce levels of homocysteine, a blood component that can damage blood vessels. Folate may also help relax the blood vessels, which helps lower blood pressure and improve circulation. People can obtain folate in their diets by eating citrus fruits and juices; dark, leafy green vegetables; and dried beans and peas. Folate is also available in pill form as folic acid.
Niacin (vitamin B3)When taken at very high doses, niacin raises HDL cholesterol, and lowers LDL cholesterol and triglycerides. Although available as a dietary supplement, prescription niacin is preferred to the dietary supplement niacin. Dietary supplements are not regulated by the Food and Drug Administration (FDA), and may contain variable amounts of niacin and cause serious side effects.
Omega-3 fatty acids (DHA and EPA)Omega-3 fatty acids are a group of polyunsaturated fatty acids (such as fish oil) that are not made by the body. Studies have found that omega-3 fatty acids may lower blood pressure, help people with cardiovascular disease, and slow the progression of atherosclerosis. Two types of omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). DHA and EPA have been shown to decrease triglycerides and may raise HDL (good) cholesterol.
Food sources of omega-3 fatty acids include fatty fish (bass, halibut, herring, mackerel, salmon, sardines, trout, and tuna) and vegetable sources (canola oil, soybean oil, flaxseeds, and walnuts). Fish oil pills are also available.
Plant Sterols and StanolsPlant sterols and stanols lower LDL cholesterol levels in the blood by blocking the absorption of cholesterol. Small amounts of sterols and stanols are found in many fruits, grains, legumes, nuts, seeds, vegetables, and vegetable oils. Fortified foods with higher levels of sterols and stanols include margarine, salad dressings, and snack bars. Dietary supplements are also available.
Relaxation techniquesThe following relaxation techniques are designed to relieve stress and may help lower blood pressure levels:
Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
- Deep breathing
Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
- Qi gong
Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
- RESPeRATE Blood Pressure Lowering Device
RESPeRATE is an FDA-approved portable electronic device that helps lower blood pressure naturally by helping people to master the technique of paced breathing.
Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.