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  • Treatment Options for Coronary Artery Disease

     
     
     
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    Over the last 20 years, there has been a revolution in the treatment of coronary artery disease-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. You can also 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 coronary artery disease, depending on your health profile and symptoms, including:

    * Cholesterol-lowering medications. Statins and other medications are often very effective in lowering blood levels of LDL or "bad" cholesterol. Other medications may be used to raise levels of HDL or "good" cholesterol. Together, these two steps can slow or stop plaque build-up in your arteries.
    * Beta blockers. These medications slow your heart rate and reduce the heart's demand for oxygen. Your doctor may prescribe a beta blocker if you have high blood pressure or angina, or have had a heart attack.
    * Aspirin. By warding off blood clots, aspirin can help save your life during a heart attack. If you've already had a heart attack, taking a low-dose aspirin daily can help prevent another heart attack. Researchers are investigating whether people who have several risk factors for heart disease should take aspirin to prevent a first heart attack, but the answer to that question is not yet clear.
    * Angiotensin-converting-enzyme (ACE) inhibitors. These medications are used to treat high blood pressure. In addition, if you've had a heart attack, taking an ACE inhibitor can prevent another heart attack.
    * Calcium-channel blockers. These medications relax blood vessels, which reduces high blood pressure and lightens your heart's workload as it pumps blood throughout the body. Some types of calcium-channel blockers also slow the heart rate. A lighter workload means your heart muscle needs less oxygen-rich blood, and reduces the likelihood that you'll develop chest pain.
    * Nitroglycerin. Nitroglycerin, and other forms of nitrates, cause your arteries and veins to relax. This lightens the heart's workload by reducing the pressure the heart has to pump against. If you have CAD and have been experiencing angina, your doctor may advise you to carry nitroglycerin tablets or spray with you at all times. Dissolving a nitroglycerin tablet under your tongue or between your cheek and gums, can quickly relieve chest pain. Some people with CAD also use longer-acting nitrates to prevent angina from developing.

    Catheter-based therapies. If a blockage or plaque is severe enough, your doctor may recommend treating it with minimally invasive procedures such angioplasty and stenting. With this form of treatment, an interventional cardiologist expands the obstructed artery by positioning a slender 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.

    Surgery. Some people with coronary artery disease have widespread plaque in several arteries, or a severe narrowing in the main artery that transports blood from the aorta to the heart. In this situation, your doctor may decide that it is safer and more effective for you to have coronary artery bypass graft (CABG) surgery, rather than angioplasty and stenting. During bypass surgery, arteries or veins are taken from other parts of the body, such as the chest and the legs, and sewn onto the diseased arteries in the heart, above and below the obstructive plaque. The new arteries and veins serve to detour blood flow around the plaque, keeping blood flowing to the heart muscle.