Treatment of Heart Disease

There are several treatment methods that will help improve blood flow through the arteries:

Medications

Beta-blockers, such as atenol (Tenormin), nadolol (Corgard), metoprolol (Lopressor, Toprol XL), and propranolol (Inderal), lower blood pressure by reducing the amount of blood pumped by the heart. These drugs may also reduce the risk of a subsequent heart attack in patients who have already had one. Possible side effects include fatigue, impotence, abnormalities in fatty substances in the blood and interference with blood-sugar regulation. . (View list of beta-blockers)

Calcium channel blockers, such as amlodipine (Norvasc), diltiazem (Cardizen, Tiazac), nifedipine (Adalat, Procardia), nisoldipine (Sular), and verapamil (Calan, Isoptin, Verelan), relax blood vessel walls, thereby lowering pressure. They are also quite expensive and may cause side effects such as constipation and swollen legs. There are also Nitrate-based drugs and vasodilator drugs. (View list of calcium channel blockers)

Diuretics, such as chlorothiazide (Diuril) and hydrochlorothiazide (Esidrix), lower blood pressure by causing the body to expel excess fluids and sodium through urination. If the desired effects aren't realized with diuretics alone, in combination they may enhance the effect of other blood pressure medications. (View list of diuretics).

Angiotensin-Converting Enzyme (ACE) Inhibitors, such as captopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil, Zestril), expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart's work easier. (View list of ACE inhibitors).

Angiotensin-2 (AT-2) receptor antagonists, such as candesartan (Atacand) and

irbesartan (Avapro), have been shown to achieve effects similar to those found in ACE inhibitors. Instead of lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers prevent it from effecting the heart and blood vessels. This keeps blood pressure from rising.

Statins, such as atorvastatin (Lipitor), pravastatin (Pravachol), and rosuvastatin calcium (Crestor), are very effective in lowering LDL ("bad") cholesterol levels and have few short-term side effects. They work in the liver to interrupt the formation of cholesterol from the circulating blood. (View list of statins). Ezetimibe (Zetia) is a newer drug that lowers LDL (“bad”) cholesterol by working in the digestive tract to reduce the absorption of cholesterol. It is sometimes prescribed along with a statin.

Balloon Angioplasty

A nonsurgical procedure designed to dilate (widen or expand) narrowed coronary arteries. It works as follows:

First, a doctor inserts a thin plastic tube (a catheter) into an artery in your arm or leg. He or she then guides this catheter to the aorta (the large artery that conducts blood from the heart to the rest of the body). From there it passes into the coronary arteries.

As the doctor guides the catheter to the coronary arteries, the procedure is monitored by a special x-ray camera called a fluoroscope. Once the catheter is passed into the narrowed coronary artery, a second, smaller catheter with a balloon on its' tip is passed through the first catheter. You can think of this as one "pipe" passed through another.

As this second catheter is passed through the first, the balloon remains deflated; however, once the balloon tip reaches the narrowed part of the coronary artery, it's inflated. When the balloon is inflated, it compresses the plaque and enlarges the diameter of the opening within the blood vessel. After that, the balloon is deflated and the catheters are withdrawn.

The result of this procedure is that the blood vessel is dilated, and blood can flow more easily through the (formerly narrowed) part of the coronary artery.

In some situations, a small hollow tube made of metal mesh, called a stent, is used to keep the blood vessel open after a balloon angioplasty. There are new types of stents, called drug-eluting stents, that are coated with immunosuppressants that are slowly released and help keep the blood vessel from reclosing. These new stents, a sirolimus-eluting stent (Cypher) and a paclitaxel-eluting stent (Taxus), have shown some promise for improving the long-term success of this procedure.

Bypass Graft Surgery

Bypass graft surgery was introduced as a way of treating coronary artery disease. In this operation (abbreviated as CABG and sometimes pronounced "cabbage"), cardiac surgeons remove part of the blood vessel (graft) from somewhere else in the body and attach it to a narrowed or blocked coronary artery so the muscle ordinarily supplied by the vessel can be nourished again. For many people who suffer from unremitting angina, CABG can provide dramatic relief.

The principle of bypass graft surgery is to construct a new channel so blood can get around the atherosclerotic blockages in the coronary arteries. Therefore, instead of trying to scrape out the plaques, the surgeon uses a segment of a vessel from another part of the body to transport blood to the far side of the obstruction. Usually the grafts are fashioned from one of the large, accessible saphenous veins that run down the inside of the leg, although recently there has been a trend towards using the internal mammary arteries located under the chest wall.

Electrophysiologic devices (Pacemakers)

The job of the pacemaker is to maintain a minimum safe heart rate by delivering to the pumping chambers appropriately timed electrical impulses that replace the heart's normal rhythmic pulses.

The device designed to perform this life-sustaining role consists of a power source about the size of a silver dollar (containing the battery) and, control circuits, and wires, or "leads, that connect the power source to the chambers of the heart.

The leads are placed in contact with the right atrium or the right ventricle, or both. They allow the pacemaker to sense and stimulate in various combinations, depending on where the pacing is required.