What are my treatment options for coronary artery disease?
Treatment of coronary artery disease involves reducing your risk factors, taking prescribed medications as instructed and possibly undergoing minimally invasive or surgical procedures. It is important to see your cardiologist regularly to reduce your risk of heart attack or stroke.
Reducing your risk factors involves making lifestyle changes such as the following:
- Smoking cessation
- Dietary changes to reduce cholesterol, control blood pressure and manage blood sugar if you have diabetes
- Limiting alcohol consumption to one drink per day
- Increase your exercise/activity level to help achieve and maintain a healthy weight and reduce stress
Taking your medications as prescribed is important if lifestyle changes in itself are not enough to control your heart disease. These may include the following:
- Antiplatelet medications (aspirin, clopidogrel, prasugrel)
- Beta blockers (metoprolol, labetalol, propranolol)
- ACE inhibitors (benazepril, Ramipril, captopril)
- ARBs (losartan, olmesartan, valsartan)
- Anticoagulants (warfarin, xarelto, heparin, enoxaparin)
- Calcium channel blockers (amlodipine, diltiazem, nifedipine)
- Statins to lower cholesterol (atorvastatin, pravastatin, simvastatin)
- Digitalis medications (digoxin)
- Nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
Procedures may be recommended to treat your coronary artery disease which could be either minimally invasive or surgical and include the following:
- Interventional procedures: this procedure is minimally invasive and involves your cardiologist accessing your heart using a long, thin tube (catheter) that is inserted into a blood vessel. Several types of balloons or catheters can be used to treat the plaque build up within the artery walls. Balloon angioplasty involves deployment of a special balloon at the end of the catheter that is inflated and deflated several times in order to compress the plaque against the walls of the artery. This widens the opening of the blood vessel, so blood is able to flow freely through it. In some instances a mesh-like metal tube called a stent may be placed within the artery to keep it open, which may be drug-eluting, meaning it is coated in a material that allows for emission of a drug over time that decreases the risk of plaque build-up. This procedure is completed either outpatient with patients going home the same day or may require an overnight hospital stay.
- Coronary artery bypass graft (CABG) surgery: if your cardiologist is unable to open your coronary arteries using a minimally invasive method, you will be evaluated by a cardiac surgeon for CABG surgery. During this procedure, one or more of your blocked coronary arteries is bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts are created using either the patients own arteries or veins, located in the chest, arm or leg. The graft goes around the clogges artery to create a new pathway for oxygen rish blood to flow to the heart. This requires a 5-7 day hospital stay.
- Enhanced external counterpulsation (EECP): for patients who have persistent angina symptoms and have exhausted the standard treatments without successful results, EECP may stimulate the openings or formation of small branches of blood vessels (collaterals) to create a natural bypass around narrowed or blocked arteries. EECP is a noninvasive treatment for people who have chronic, stable angina; who are not receiving adequate relief from angina by taking nitrate medications; and who do not qualify for a procedure such as bypass surgery, angioplasty or stenting. This procedure is outpatient and patients go home the same day.