Treatment of Coronary Heart Disease

Although coronary heart disease cannot be cured, it can usually be managed with a combination of lifestyle changes and medication to prevent it from becoming worse. However, surgery may sometime be necessary.

1. Lifestyle Changes

CHD patients will be encouraged to make a number of lifestyle changes, such as:

• Reducing intake of saturated fat
• Stopping smoking
• Eating a healthy, varied diet
• Taking more exercise
• Limiting alcohol consumption

2. Medication

There are a number of drugs that can reduce the symptoms of coronary heart disease and improve the function of the heart. These may include:

ACE Inhibitors

ACE (Angiotensin Converting Enzyme) inhibitors are often prescribed to treat high blood pressure and heart failure. They help to improve the flow of blood around the body by blocking the activity of a hormone known as angiotensin II, which narrows blood vessels. This prevents the heart from having to work so hard.

ACE inhibitors may cause kidney problems, along with dizziness, fainting and a dry cough. Patients are monitored closely whilst they are taking this type of medication to check their kidneys are working properly.

Angiotensin II Receptor Antagonists

This type of drug works in a similar way to ACE inhibitors to lower blood pressure. However, they have fewer side effects than ACE inhibitors, and are often prescribed to patients who have reacted adversely to ACE inhibitors.

Anti-Arrhythmic Drugs

This type of medication is used to control the rhythm of the heart.

Anticoagulants

Anticoagulants such as warfarin are used to prevent the blood from clotting, thus reducing the risk of thrombosis. Regular blood tests are necessary to monitor the correct dosage of the drug. Patients must also be aware that any cuts may bleed profusely whilst using this medication.

Aspirin

Low-dosage aspirin can help to prevent the blood from clotting and reduce the risk of angina and heart attack. Aspirin will not normally be prescribed for anyone who suffers from a bleeding disorder.

Beta Blockers

Beta blockers may be prescribed to treat high blood pressure and prevent angina. They block the effects of stress hormones, which make the heart beat more forcefully and faster, thus slowing the heartbeat, helping the heart to pump more effectively and improving blood flow. This group of drugs are usually taken with diuretics and ACE inhibitors. They are not suitable for people with diabetes or for those with respiratory conditions, such as asthma.

Cardiac Glycosides

This type of medication includes drugs such as digoxin, which slows and strengthens the heartbeat. The muscles of the heart contract with greater strength, pushing the blood around the body with more force. These drugs are usually only taken in addition to other medication, such as diuretics and ACE inhibitors.

Nitrates

Nitrates are vasodilators - that is, they relax and widen the blood vessels, thus allowing more blood pass through them, lowering blood pressure and relieving heart pain. They are available as sprays, tablets, ointments and skin patches. Common side effects may include dizziness, headaches and flushed skin.

Statins

Patients with high cholesterol levels may be prescribed lipid lowering drugs, known as statins. These change the inner lining of the blood vessels to prevent plaques (deposits) from forming or from increasing in size.

3. Surgery

If a patient's symptoms cannot be controlled with drugs, then surgery may be necessary to replace or open up blocked arteries. However, surgery will not lower the blood pressure or remove the build up in the other arteries, so patients must also make suitable lifestyle changes and take any medications that they are prescribed to reduce the risk of a heart attack.

Coronary Angioplasty

This type of operation is the most common treatment for coronary heart disease. A catheter is inserted into the groin, upper leg or arm, and then threaded through to the coronary artery. A small balloon-like device is inserted into the artery through the catheter and inflated until the artery is wide enough to allow a good flow of blood. It is then deflated and removed.

Coronary Artery Bypass Surgery

This type of operation is carried out to allow the blood to bypass (get round) the blocked arteries in the heart. A vein from the leg or an artery from the chest wall is used to provide the blood with an alternative path to travel. This is a major operation and patients may take 2-3 months to recover.

Laser Surgery

This new technique uses a laser catheter to create a number of tiny holes in the heart muscle, which then encourage new blood vessels to grow into the diseased heart muscle. Although this procedure is often carried out on its own, it may also be performed in conjunction with coronary bypass surgery.

Heart Transplant

In a small number of cases, the heart may be so severely damaged that a heart transplant may be necessary. However, there may be a wait for several months for a donor, and not all patients may be suitable for this type of operation.