Treatment

Treatment of CHD varies according to the stage of development of the disease and if other complications have arisen. CHD cannot be cured, but prognosis can be improved with lifestyle changes and/or medication.

Early diagnosis - before angina or MI or

Those who are recognised early to be in a high risk have may have the best prognosis. Doctors will advise different treatments, depending on a person's individual circumstances and conditions.
Common advice and treatments given are:

- Further diagnosis. If not already done, the doctor may advise more specific investigations to see the extent of narrowing in the coronary arteries. From there, the doctor can devise a treatment plan.

- Lifestyle Changes. Perhaps, cutting the down the hours of work if working to reduce stress, or more importantly - diet change. This is also very important in prevention! Must stop smoking and drinking alcohol and try to reduce weight.

- Increase physical excercise. It's understandable that physical exertion is not possible with everyone. But for those who can manage, its strongly advisable. It reduces obesity, makes the heart healthier, reduces blood pressure and cholesterol.

- Medications. There are numerous drugs that may be prescribed, again depending on the individual's compatability or stage of development. Drugs prescribed are outlined below.

Later diagnosis - After recurrent angina or an episode of acute MI

This is an unfortunate way of discovering CHD, however, it doesn't mean fatality. Again, prognosis can be positive, but still depends on the individual case. Assuming lifestyle changes as described above have not improved the condition, stronger and/or more medications can be prescribed. The extent of a myocardial damage by a heart attack or stage of atherosclerosis may need treating by surgery.

Drug Treatments

They aim to tackle different aspects leading to narrowed arteries, or preventing the chance of a heart attack. Common drugs prescribed are outlined as follows:

- Statins are cholesterol-lowering drugs (e.g. Simvastatin). In combination with a healthy diet, it can be a very successful method to reduce the amoust of cholesterol in the body. Statins reduce cholesterol synthesis in the liver as well as reducing plasma LDL.

- Aspirin has anti-platelet properties and can prevent clotting at the plaques in coronary arteries. In brief, it does this by irreversible modification of an enzyme (Cylcooxygenase) that ultimately prevents the aggregation of platelets.

- Anticoagulants are drugs are slow the process of coagulation. The most common anticoagulants are Warfarin and Heparin. They work by preventing the impairing parts of the clotting cascade by various mechanisms that won't be explained here. Anticoagulants are prescribed to prevent the chances of a thrombus forming from a ruptured plaque. It does come with the side-effect of increased bleeding and cuts.
Dosage of anticoagulants are administered by measuring the INR (if on Warfarin) or APTTR (If on Heparin) periodically. Normal INR is 0.9-1.2 and APTTR 0.8-1.2. If on anticoagulants, the desired INR is maintained between 2.0-3.0 and APPTR 1.5-2.5
Some Hospitals/Clinics measure APTT instead; Normal range 27-38 seconds. If on Heparin, desired APTT range is maintained between 49-81 seconds.

- GTN or equivalent nitrates are used to treat angina. They have a vasodilatory effect helping to increase blood flow to prevent ischaemia. They come in various forms such as sprays, tablets and patches.

- Beta-blockers in conjuction with diuretics are used to treat angina and reduce high blood pressure. Beta-blockers work by reducing the effect the sympathetic nervous system has on the cardiovascular system. In effect, the heart is slowed down and blood pressure is reduced. Therefore, the demand for oxygen by cardiac muscle is lowered, hence, ischaema is prevented. However, beta-blockers do have their side effects!

- Thrombolytics are drugs used to break down thrombi formed from atherosclerotic plaques that have caused a heart attack. Thrombolytics work by indirectly degrading fibrin, a protein involved in clotting.

Surgical treatment

Unfortunately for some, the damage is so great that medication will not or hasn't worked. Surgical procedures performed to treat Coronary Heart disease are:

- Coronary Artery Bypass involves taking a graft vessel (e.g. the saphenous vein from the leg) and attaching it from the aorta to a point beyond the occlusion of the coronary artery. So, as the name suggests - a graft to bypass the blocked coronary artery.


- Coronary Angioplasty (with/without stenting) is a technique in which a baloon on the tip of a catheter is fed through to the area of the plaque of the coronary artery. The baloon is inflated, widening the diameter of the artery and squashing the atheroma. The baloon is then deflated and removed.
Sometimes, a thin metal mesh (known as the stent) is inserted as well. This is an extra precaution the prevent the re-occlusion of the artery. (See diagram above)
A drawback of a coronary angioplasty is that the lipid plaque can build up to narrow the artery again, so the procedure may need to be repeated.

- Heart Transplant may be suggested in the extreme case that the heart is so severely damaged that it ought to be replaced. This is probably the last choice after all else has failed and of course, transplantation has is own serious implicatios such as rejection.

References [Show/Hide]