Coronary artery disease may reduce the flow of blood to the heart muscle. Symptoms of angina occur when the blood flow does not meet the demands of the heart. The treatment for angina requires medications that reduce stress on the heart and prevent blood clots from forming in the bloodstream. New or worsening angina, called unstable angina, requires immediate treatment in the emergency room. If severe coronary artery disease results in a heart attack, treatment involves thrombolytic therapy, emergency coronary angioplasty, or emergency bypass surgery.

Without angina, the treatment for coronary artery disease depends on the extent of the blockage. In some cases, mild coronary artery disease may be treated with medications that reduce the risk for worsening coronary artery disease. Treatment for more advanced coronary artery disease includes coronary artery angioplasty and stenting, or coronary artery bypass surgery, which restore the normal blood flow to the heart muscle.

Initial treatment of angina due to coronary artery disease in the emergency department includes:

• Cardiac monitoring
• Oxygen
• Intravenous fluids
• Medications for angina:
• Nitrates
• Nitroglycerin under the tongue
• Morphine for pain control
• Blood pressure monitoring

• Early treatment with:
• Aspirin
• Blood thinners
• Glycoprotein IIB/IIIA receptor antagonist medication
• Treatment with direct thrombin inhibitors:
• Hirudin (Lepirudin, Refludan)
• Bivalirudin (Angiomax)
• Adenosine diphosphate receptor antagonists:
• Clopidogrel (Plavix)
• Ticlopidine (Ticlid)
• Timely decision whether to provide:
• Thrombolytic medications
• Angioplasty
• Coronary artery bypass surgery
• Treatment with beta-blocker medication
• Treatment with angiotensin converting enzyme inhibitor medication
• Continued aspirin therapy after hospital discharge
• Continued beta-blocker therapy after hospital discharge
• Smoking cessation counseling
• Cardiac rehabilitation program

• Aspirin
• Beta blocker medications
• Nitroglycerin
• Angiotensin converting enzyme inhibitor medications
• Angiotensin receptor blocker medications
• Angioplasty and stenting for coronary artery disease
• Medications for high cholesterol
• Bypass surgery for coronary artery disease

• Acute coronary syndrome treatment
• Heart Attack treatment
• Angina treatment

Angioplasty is an effective treatment for reversing the effects of coronary artery disease. Angioplasty is performed during cardiac catheterization.

During angioplasty, a catheter (thin plastic tube) is advanced into the narrowed part of the coronary artery. A balloon at the end of the catheter is inflated, in order to force open the narrowed artery. Alternative techniques include cutting or burning away the blockage with a tiny blade or laser.

Examples:

• Angioplasty with balloon
• Angioplasty with laser
• Angioplasty tool

• Coronary artery stent
• Coronary artery stenting

• Allergic reaction to the dye
• Heart attack
• Coronary artery rupture
• A small number of opened arteries become narrowed again. However, stents are used to protect against this complication.

Those who suffer a heart attack or undergo bypass surgery lose physical strength because the heart is weakened and their activity has been limited. Cardiac rehabilitation helps the heart to recover. It provides a supervised exercise program that can restore exercise capacity and endurance.

Cardiac rehabilitation programs:

• Limit the effects that heart disease has on the body
• Limit the psychological impact of heart disease
• Lower the risk of heart attack and death
• Slow, halt, or possibly reverse coronary artery disease

Medications that improve blood flow through the coronary arteries include:

• Aspirin:
• Thins the blood, in to order lower the risk of blood clots in the coronary arteries
• Heparin:
• Thins the blood, in to order lower the risk of blood clots in the coronary arteries
• Nitrates:
• Open coronary arteries and let the heart work more efficiently
• Platelet inhibitors:
• Thins the blood, in order to lower the risk of blood clots in the coronary arteries
• Thrombolytics:
• Clot busting medication
• Morphine:
• Reduces anxiety and increased blood flow through coronary arteries

• ACE Inhibitors:
• Lower blood pressure and reduce the work of the heart
• Beta-blockers:
• Lower blood pressure and reduce the work of the heart
• Calcium-channel blockers:
• Reduce the work of the heart and reduce abnormal heartbeats
• Statins:
• Lower cholesterol and reduce inflammation inside the coronary arteries
• Clopidogrel (Plavix):
• Thins the blood, in order lower the risk of blood clots in the coronary arteries
• Ranolazine (Ranexa):
• Helps improve oxygen levels in heart muscle.
• This drug is most often used when the above anti-anginal medications are not effective.

• Angina treatment drugs aspirin
• Angina treatment drugs beta-blockers
• Angina treatment drugs blood thinners
• Angina treatment drugs CCBs
• Angina treatment drugs nitrates
• Angina treatment drugs statins

The long-term treatment of coronary artery disease depends on the severity, the condition of the heart and the presence of other diseases.

• Regular exercise program
• Eat a healthy diet:
• Low cholesterol diet
• Low fat diet
• Low salt diet
• Weight loss if you are overweight
• Stop smoking.
• Avoid exposure to secondary smoke.
• Reduce stress.
• Cardiac rehabilitation
• Control other diseases:
• High blood pressure
• High cholesterol
• Diabetes
• Vitamin B supplements

• ACE Inhibitors:
• Lower blood pressure and reduce the work of the heart
• Aspirin:
• Thins the blood, in order lower the risk of blood clots in the coronary arteries
• Beta-blockers:
• Lower blood pressure and reduce the work of the heart
• Calcium channel blockers:
• Reduce the work of the heart and reduce abnormal heartbeats
• Statins:
• Lower cholesterol and reduce inflammation inside the coronary arteries
• Clopidogrel (Plavix):
• Thins the blood, in order lower the risk of blood clots in the coronary arteries
• Nitrates:
• Open coronary arteries and let the heart work more efficiently

The following are some important questions to ask before and after the treatment of coronary artery disease.

Questions to ask before treatment:

• What are my treatment options?
• Is surgery an option for me?
• What are the risks associated with treatment?
• Do I need to stay in the hospital?
• How long will I be in the hospital?
• What are the complications I should watch for?
• How long will I be on medication?
• What are the potential side effects of my medication?
• Does my medication interact with nonprescription medicines or supplements?
• Should I take my medication with food?

• Do I need to change my diet?
• Are there any medications or supplements I should avoid?
• Do I need to lose weight?
• When can I resume my normal activities?
• When can I return to work?
• Do I need a special exercise program?
• What else can I do to reduce my risk for complications?
• How often will I need to see my doctor for checkups?
• What local support and other resources are available?

Physicians from the following specialties evaluate and treat coronary artery disease:

• Cardiology
• Internal Medicine
• Family Practice

Blocked coronary arteries require bypass surgery. The aim is to provide blood flow to the artery beyond the blockage, bypassing the obstruction. Small arteries in the chest wall, or veins from the legs, are removed for this purpose. A small segment of the bypass vessel is attached to the wall of the diseased vessel, where blood flow is strong. And then, the other end of the bypass vessel is attached to the blocked vessel, beyond the blockage. This allows blood to flow around the blockage, restoring the delivery of oxygen and nutrients to the part of the heart that was supplied by the vessel before it became blocked.

Example:

• Coronary artery bypass surgery

• Death: 3%
• Heart attack: 5%
• Stroke: 2%

Last Updated: Jun 7, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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