Coronary Heart Disease

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Coronary Heart Disease Treatment

The treatment for CHD varies depending on the symptoms and how much the disease has progressed. The general treatments include lifestyle changes, medications, and sometimes surgery.

Lifestyle changes may include:

• A weight reduction program
• A low saturated fat / low cholesterol diet to help reduce cholesterol
• Reducing sodium (i.e., salt) ingestion to keep high blood pressure under control
• A routine exercise regimen
• Permanently discontinuing cigarette smoking

Medications may include:

• Cholesterol-lowering medication
• Antiplatelet agents such as aspirin, ticlopidine, or clopidogrel to reduce the risk of blood clots
• Glycoprotein IIb-IIIa inhibitors such as abciximab, eptifibatide, or tirofiban, to reduce the risk of blood clots
• Antithrombin agents such as blood-thinners (low-molecular heparin, unfractionated heparin), to reduce the risk of blood clots
• Beta-blockers to decrease heart rate and to lower oxygen consumption by the heart
• Nitrates such as nitroglycerin to dilate the coronary arteries and improve blood supply to the heart.
• Calcium-channel blockers to relax the coronary arteries and all systemic arteries and thus reduce the workload for the heart.
• ACE inhibitors, diuretics, or other medications to lower blood pressure.

Interventions may include:

• Percutaneous Coronary Interventions (PCI's):
  • Coronary angioplasty (Balloon PTCA).
  • Coronary atherectomy.
  • Ablative laser-assisted angioplasty.
  • Catheter-based thrombolysis and mechanical thrombectomy.
  • Coronary stenting (placing a tube in the artery to keep it open).

  • Coronary radiation implant or coronary brachytherapy: Brachytherapy consists of the intracoronary delivery of beta or gamma radiation. This new treatment strategy is reserved for patients who have undergone stent implantation in a coronary artery and then have developed problems such as diffuse in-stent restenosis. Coronary brachytherapy is a promising technique but currently limited by certain complications such as edge restenosis and late thrombotic occlusion. In addition, the long-term effects of radiation are still unknown as coronary brachytherapy was only approved by the FDA for clinical use in late 2000. The FDA approval of brachytherapy is currently restricted to treatment of problems involving sents, although in some medical centers brachytherapy is being studied as a first-line treatment of coronary disease.

• Surgical Interventions:
  • Coronary artery bypass surgery.
  • Minimally invasive heart surgery.