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Coronary heart disease

Overview Symptoms Treatment Prevention

Alternative Names:

Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

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:

Losing weight
A low saturated fat, low cholesterol diet to help reduce cholesterol
Reducing sodium (i.e., salt) to keep high blood pressure under control
Regular exercise
Quitting 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 drugs, such as blood-thinners (low-molecular heparin, unfractionated heparin), to reduce the risk of blood clots
Beta-blockers to decrease heart rate and lower oxygen use 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

Percutaneous Coronary Interventions (PCI's) include:

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

Coronary brachytherapy consists of delivering beta or gamma radiation into the coronary arteries. This new treatment is reserved for patients who have undergone stent implantation in a coronary artery and but developed problems, such as diffuse in-stent restenosis. Brachytherapy is a promising technique but is currently limited by certain complications. In addition, the long-term effects of radiation are unknown, as coronary brachytherapy was only approved by the FDA in late 2000. FDA approval of brachytherapy is currently restricted to treatment of stent-related problems, although in some medical centers brachytherapy is being studied as a first-line treatment of coronary disease.

Surgical procedures include:

Expectations (prognosis):

The outcome is variable. Some people can maintain a healthy life by changing diet, stopping smoking, and taking medications as long as they are closely monitored. Others may require more drastic measures, such as surgery. Everyone is different, but one important caveat is detecting CHD early and treating it appropriately.

Complications:

Calling your health care provider:

If you have any of the risk factors for CHD, you should contact your health care provider for appropriate prevention and treatment. If you experience angina, shortness of breath, or symptoms of a heart attack, contact your health care provider, call 911 or go to the emergency room immediately.

Heart, section through the middle	Heart, front view	Acute MI	Posterior heart arteries
Cholesterol producers	Anterior heart arteries

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