Coronary heart disease - Treatment

Treatment-Coronary heart disease




Treatment for coronary heart disease (CHD) can help manage the symptoms and reduce the risk of further problems.
CHD can be managed effectively with a combination of lifestyle changes, medicine and, in some cases, surgery.
With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.

Lifestyle changes

If you've been diagnosed with CHD, you can reduce your risk of further episodes by making simple lifestyle changes.
For example, stopping smoking after a heart attack quickly reduces your risk of having a heart attack in the future to near that of a non-smoker.
Other lifestyle changes, such as eating more healthily and doing regular exercise, will also reduce your future risk of heart disease.
Read more about preventing CHD.
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Medicines

Many different medicines are used to treat CHD. Usually they either aim to reduce blood pressure or widen your arteries.
Some heart medicines have side effects, so it may take a while to find one that works for you. Your GP or specialist will discuss the various options with you.
Heart medicines should not be stopped suddenly without the advice of your doctor as there is a risk this may make your symptoms worse.

Antiplatelets

Antiplatelets are a type of medicine that can help reduce the risk of a heart attack by thinning your blood and preventing it clotting.
Common antiplatelet medicines include:

Statins

If you have a high cholesterol level, cholesterol-lowering medicine called statins may be prescribed. Examples include:
  • atorvastatin
  • simvastatin
  • rosuvastatin
  • pravastatin
Statins work by blocking the formation of cholesterol and increasing the number of  low density lipoprotein (LDL) receptors in the liver. This helps remove LDL cholesterol from your blood, which makes a heart attack less likely. 
Not all statins are suitable for everyone, so you may need to try several different types until you find one that is suitable.

Beta-blockers

Beta-blockers – including atenolol, bisoprolol, metoprolol and nebivolol – are often used to prevent angina and treat high blood pressure.
They work by blocking the effects of a particular hormone in the body, which slows down your heartbeat and improves blood flow.

Nitrates

Nitrates are used to widen your blood vessels. Doctors sometimes refer to nitrates as vasodilators. They're available in a variety of forms, including tablets, sprays and skin patches such as glyceryl trinitrate and isosorbide mononitrate.
Nitrates work by relaxing your blood vessels, letting more blood pass through them. This lowers your blood pressure and relieves any heart pain you have. Nitrates can have some mild side effects, including headaches, dizziness and flushed skin.

ACE (angiotensin-converting enzyme) inhibitors

ACE inhibitors are commonly used to treat high blood pressure. Examples include ramipril and lisinopril. They block the activity of a hormone called angiotensin II, which causes the blood vessels to narrow.
As well as stopping the heart working so hard, ACE inhibitors improve the flow of blood around the body. 
Your blood pressure will be monitored while you're taking ACE inhibitors, and regular blood tests will be needed to check that your kidneys are working properly. Around one in ten people have kidney problems as a result of taking the drug.
Side effects of ACE inhibitors can include a dry cough and dizziness.

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists work in a similar way to ACE inhibitors. They are used to lower your blood pressure by blocking angiotensin II.
Mild dizziness is usually the only side effect. They're often prescribed as an alternative to ACE inhibitors, as they don't cause a dry cough.

Calcium channel blockers

Calcium channel blockers also work to decrease blood pressure by relaxing the muscles that make up the walls of your arteries. This causes the arteries to become wider, reducing your blood pressure.
Examples include amlodipine, verapamil and diltiazem. Side effects include headaches and facial flushing, but these are mild and usually decrease over time.

Diuretics

Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine.

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Procedures and surgery

If your blood vessels are narrow as the result of a build-up of atheroma (fatty deposits) or if your symptoms can't be controlled using medication, interventional procedures or surgery may be needed to open up or bypass blocked arteries.
Some of the main procedures used to treat blocked arteries are outlined below.

Coronary angioplasty

Coronary angioplasty is also known as percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty.
Angioplasty may be a planned procedure for some people with angina, or an urgent treatment if the symptoms have become unstable.
Having a coronary angiogram will determine if you're suitable for treatment. Coronary angioplasty is also performed as an emergency treatment during a heart attack.
During angioplasty, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily. A metal stent (a wire mesh tube) is usually placed in the artery to hold it open. Drug-eluting stents can also be used. These release drugs to stop the artery narrowing again.

Coronary artery bypass graft

Coronary artery bypass grafting (CABG) is also known as bypass surgery, a heart bypass, or coronary artery bypass surgery.
It's performed in patients where the arteries become narrowed or blocked. A coronary angiogram will determine if you're suitable for treatment. Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery. It's performed while the heart continues to pump blood by itself without the need for a heart-lung machine.
A blood vessel is inserted (grafted) between the aorta (the main artery leaving the heart) and a part of the coronary artery beyond the narrowed or blocked area. Sometimes one of your own arteries that supplies blood to the chest wall is used and diverted to one of the heart arteries. This allows the blood to bypass (get around) the narrowed sections of coronary arteries.

Heart transplant

In a small number of cases, when the heart is severely damaged and medicine is not effective, or when the heart becomes unable to adequately pump blood around the body (heart failure), a heart transplant may be needed.
A heart transplant involves replacing a heart that is damaged or is not working properly with a healthy donor heart. 
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