Heart 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:

Cardiologists
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
Electrophysiologists are cardiologists who specialize in arrhythmias.

Additional members of the healthcare team may include:

Counselors or psychologists
Dietitians
Exercise specialists
Family doctor
Nurses
Occupational therapists
Physical therapists

Common heart disease treatments include:

Lifestyle changes
Medications
Procedures and surgery
Cardiac rehabilitation
Complementary and alternative medicine

Lifestyle changes

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 Diet

The 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
- 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).
Fluids
- 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)

Exercising

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.

Managing weight

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 home

Some 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 home

Home 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 home

People 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.

Reducing stress

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).

Smoking cessation

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 groups

Heart disease support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.

Medications

Medications are used when lifestyle changes don't sufficiently lower a person's heart disease risk factors or their heart disease symptoms worsen. 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

Coronary artery disease medications include:

Cholesterol-lowering drugs (such as statins, bile acid sequestrants, niacin, and fibrates)
Antiplatelet drugs (aspirin and other blood thinners)
Blood pressure drugs (including ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics)
Nitrates (such as nitroglycerin)

Hospitalization for coronary artery disease

People with coronary artery disease may require hospitalization. During their hospital stay, they may be given oxygen and intravenous medications in the hospital. Additional procedures or surgeries may be performed to improve the blood flow to diseased coronary arteries.

Angina medications

Angina medications include:

Antiplatelet drugs (aspirin and other blood thinners)
Nitrates (such as nitroglycerin)
Cholesterol-lowering drugs (such as statins, bile acid sequestrants, niacin, and fibrates)
Ranolazine (Ranexa)

Heart attack medications

Heart attack medications include:

Antiplatelet drugs (aspirin and other blood thinners)
Blood pressure drugs (including ACE inhibitors and beta-blockers)
Nitrates (such as nitroglycerin)

Doctors may also advise people who've already had a heart attack to take low-dose aspirin daily to reduce the risk of a second heart attack.

Emergency care for a heart attack

A heart attack is a medical emergency. People who suspect they're having a heart attack or people who witnesses someone they suspect is having a heart attack should call 911 or their local emergency number immediately. If emergency assistance isn't available, someone should drive the person exhibiting the symptoms to the nearest hospital. Driving alone while experiencing heart attack symptoms can be dangerous and should only be considered as a last resort. People under medical supervision may take nitroglycerin or aspirin as advised until help arrives.

A defibrillator is a device designed to restore a normal heart rhythm to a person having a heart attack. HeartStart is a battery-powered home defibrillator, which can be used to treat a person who experiences sudden cardiac arrest . The device also includes step-by-step CPR coaching if needed. It's important to call 911 or the local emergency phone number before using HeartStart.

Emergency healthcare providers often are able to diagnose and start treatment on the way to the hospital. People experiencing heart attack symptoms are typically first brought to the hospital's emergency department. Once their condition is stabilized, they are usually transferred to an intensive care unit (ICU) or a coronary care unit (CCU).

During their hospital stay, people are connected to an ECG (electrocardiograph) monitor to record the electrical activity of their heart.

Medications may include:

Oxygen to reduce the amount of work required for the heart to provide oxygen to the rest of the body.
Aspirin or other antiplatelet medications to limit blood clotting.
Nitroglycerin to control chest pain, widen blood vessels, and increase blood supply to the heart.
Pain medications, such as morphine or meperidine (Demerol)
Thrombolytics (clot busters) to dissolve blood clots that are obstructing blood flow to the heart. Thrombolytics must be given within a few hours after the start of heart attack symptoms.

Heart failure medications

Heart failure medications include:

Aldosterone antagonists
Blood pressure drugs (including ACE inhibitors, Angiotensin II (A-II) receptor blockers, beta-blockers, and diuretics)
Digoxin (digitalis)

Hospitalization for heart failure

People with heart failure may require hospitalization. During their hospital stay, they may be given their medications intravenously with supplemental oxygen provided for people who have trouble breathing.

Heart arrhythmias medications

Heart arrhythmia medications include:

Antiarrhythmic drugs
Blood pressure drugs (including beta-blockers and calcium channel blockers)
Digoxin (digitalis)

Explanations of heart disease medications

Aldosterone antagonists

Aldosterone antagonists are used in combination with other heart failure drugs. They work by blocking the action of aldosterone, a substance naturally in the body that raises blood pressure. Examples include:

eplerenone (Inspra)
spironolactone (Aldactone)

Antiarrhythmic drugs

Antiarrhythmic drugs correct irregular heartbeat, or slow down or speed up a person's heartbeat. Examples include:

amiodarone (Cordarone, Pacerone)
Digoxin (Digoxin, Digitek, Lanoxin)
disopyramide (Norpace)
dofetilide (Tikosyn)
mexiletine (Mexitil, Mexiletine HCL)
procainamide (Procan, Procanbid)
quinidine (Quinidine Gluconate, Quinidine Sulfate)
tocainide (Tonocard)

Antiarrhythmic drugs may make an arrhythmia worse or even cause a different kind of arrhythmia. Some may increase a person's risk of death, especially if they've had a previous heart attack.

Antiplatelet drugs

Antiplatelet 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:

Digoxin

Digoxin (digitalis) slows the electrical activity of the heart, increases the force of heart muscle contractions, and improves circulation. It is especially helpful when ACE inhibitors and diuretics don't work.

Digoxin (Digitek, Digoxin, Lanoxin)

Nitrates

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:

isosorbide dinitrate (Isordil)
nitroglycerin (Nitro-Bid, Nitro-Dur, Nitroglycerin, Nitroglycerin CR, NitroQuick)

Ranolazine

Ranolazine improves blood flow to the heart and reduces the heart's workload. Ranolazine is taken in combination with a person's current angina medication when the current medication does not relieve the angina pain. Although Ranolazine may prevent angina episodes, it cannot relieve an angina episode once it starts.

ranolazine (Ranexa)

Cholesterol-lowering medications

Cholesterol 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:

Statins

Statin 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:

atorvastatin (Lipitor)
fluvastatin (Lescol)
lovastatin (Mevacor)
pravastatin (Pravachol)
rosuvastatin Calcium (Crestor)
simvastatin (Zocor)

Bile acid sequestrants

Bile 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:

cholestyramine (Questran, Prevalite)
colestipol (Colestid)
colesevelam (WelChol)

Niacin

Niacin (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:

nicotinic acid (Niacor, Niaspan)

Fibrates

Fibrates 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:

gemfibrozil (Lopid)
fenofibrate (Lofibra, Tricor)

Blood pressure medications

Several 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) inhibitors

Angiotensin-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 blockers

Blood 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 medications

here 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.

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:

candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
telmisartan (Micardis)
valsartan (Diovan)

Diuretics

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:

amiloride (brand name: Midamor)
bumetanide (Bumex)
chlorothiazide (Diuril)
chlorthalidone (Hygroton)
furosemide (Lasix)
hydrochlorothiazide (Esidrix, Hydrodiuril)
indapamide (Lozol)
spironolactone (Aldactone)

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:

aliskiren (Tekturna)

Tekturna may be combined with hydrochlorothiazide (a diuretic) to reduce blood pressure levels even further.

Beta-blocker + diuretic

atenolol and chlorthalidone (Tenoretic)
bisoprolol and hydrochlorothiazide (Ziac)
nadolol and bendroflumethiazide (Corzide)
propranolol and hydrochlorothiazide (Inderide)
timolol and hydrochlorothiazide (Timolide)

ACE inhibitor + diuretic

benazepril and hydrochlorothiazide (Lotensin HCT)
enalapril and hydrochlorothiazide (Vaseretic)
lisinopril and hydrochlorothiazide (Prinzide and Zestoretic)
moexipril and hydrochlorothiazide (Uniretic)
quinapril and hydrochlorothiazide (Accuretic)

Angiotensin II receptor antagonist + diuretic

irbesartan and hydrochlorothiazide (Avalide)
losartan and hydrochlorothiazide (Hyzaar)
valsartan and hydrochlorothiazide (Diovan HCT)

ACE inihibitor + calcium channel blocker

Alpha blockers

Alpha blockers lower blood pressure by reducing nerve impulses that constrict blood vessels and slow the heartbeat. Examples include:

doxazosin mesylate (Cardura)
prazosin hydrochlorothiazide (Minipress)
terazosin hydrochloride (Hytrin)

Alpha-beta blockers

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:

carvedilol (Coreg)
labetalol hydrochloride (Normodyne, Trandate)

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:

clonidine hydrochloride (Catapres)
clonidine hydrochloride and chlorthalidone (Clorpres, Combipres)
guanabenz Acetate (Wytensin)
guanfacine hydrochloride (Tenex)
methyldopa (Aldomet)
methyldopa and chlorothiazide (Aldoclor)
methyldopa and hydrochlorothiazide (Aldoril)

Vasodilators

Vasodilators lower blood pressure by preventing the blood vessel muscles from constricting (narrowing). Examples include:

diazoxide (Proglycem)
hydralazine (generic only)
minoxidil (generic only)

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

Angioplasty
Atherectomy
Coronary artery bypass surgery
Minimally invasive heart surgery

Angina procedures and surgery

Angioplasty
Atherectomy
Coronary artery bypass surgery
Minimally invasive heart surgery

Heart attack procedures and surgery

Angioplasty
Atherectomy
Coronary artery bypass surgery
Minimally invasive heart surgery

Heart failure procedures and surgery

Heart failure surgery is performed when lifestyle changes and medications aren't successful.

Heart valve surgery
Heart transplant
Left ventricular assist device

Heart arrhythmias procedures and surgery

Cardioversion or defibrillation
Implantable cardioverter defibrillator
Pacemaker
Radiofrequency ablation
Vagal maneuvers

Explanation of procedures

Angioplasty and stenting

Coronary 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.

Atherectomy

Coronary 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.

Cardioversion or defibrillation

An electrical current ("shock") is used to reset a person's heart to its regular rhythm. An anesthetic is used for sedation when the procedure is performed in a hospital.

Coronary artery bypass surgery

Coronary 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.

Heart transplant

A heart transplant is surgical procedure that removes and replaces a diseased heart with a healthy heart from a deceased donor. Heart transplantation is used when all other treatments for heart failure are unsuccessful. A heart transplant recipient must be sick enough to require a new heart but be healthy enough to survive the surgery.

During the heart transplant, a heart-lung bypass machine oxygenates and circulates the blood. After the transplant, antirejection (immunosuppressive) drugs are needed to prevent rejection of the transplanted heart. It's important for people need to watch for signs of infection (coughing, fever, sore throat; or incision inflammation, drainage, redness).

Heart valve surgery

Heart valves control the direction that blood flows within the heart. Heart valve surgery repairs or replaces diseased heart valves. A heart-lung bypass machine is used to oxygenate and circulate the blood during the surgery.

Artificial valves are most commonly used, which require life-long anti-clotting medication. Sometimes a valve from animal tissue (usually pig's aortic valve) or human organ donor is used. Animal or human donor valves rarely require antirejection drugs.

Implantable cardioverter-defibrillator

An implantable cardioverter defibrillator (ICD) helps control life-threatening, irregular heartbeats. The battery-operated device contains a built-in pacemaker. The ICD is implanted in a person's chest and continuously monitors a person's heartbeats. Electrical pulses or shocks return an abnormal rhythm to a normal rhythm.

Left ventricular assist device

A left ventricular assist device (LVAD or heart pump) helps a weak heart pump blood to the rest of body. LVAD is often used by people who are waiting for a donor heart to become available for heart transplant surgery.

Permanent LVADs have recently been used to help people who are not healthy enough to undergo heart transplantation.

Minimally invasive heart surgery

Minimally 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.

Pacemaker

A pacemaker uses electrical pulses to make the heart beat with a normal rhythm. The device is placed under the skin of the chest or abdomen. Temporary pacemakers may be used during an emergency or until a permanent pacemaker is implanted.

Radiofrequency ablation

Radiofrequency ablation normalizes some types of arrhythmias by stopping selected heart muscle cells from creating extra impulses that cause the heart to beat rapidly. A catheter with an electrode at its tip is inserted in the body and advanced to the heart muscle. Mild, painless radiofrequency energy is then used to destroy the carefully selected heart muscle cells.

Vagal maneuvers

Vagal maneuvers are a technique that sometimes helps slow down or stop a fast heartbeat (supraventricular arrhythmia). The maneuvers stimulate the vagus nerve, which slows the heartbeat. Excessive stimulation can stop it entirely.

If appropriate, a doctor may recommend the following vagal maneuvers to some people and explain how to use them safely:

Gagging
Coughing
Holding their breath and straining
Immersing their faces in ice water
Putting fingers on their eyelids and pressing down gently

Cardiac rehabilitation

Cardiac 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.

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 Extract

Artichoke leaf extract is made from the lower leaves of the artichoke plant Studies indicate that artichoke leaf extract may lower LDL cholesterol levels.

Biofeedback

Biofeedback 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 Q10

Coenzyme 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.

Folate

Folate is a B vitamin that has 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 Stanols

Plant 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 techniques

The following relaxation techniques are designed to relieve stress and may help lower blood pressure levels:

Acupuncture
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
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.

Back | Top | Next