How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines, and special procedures. The goals of treatment are to:

• Relieve symptoms
• Slow or stop atherosclerosis by controlling or reducing the risk factors
• Lower the risk of having blood clots form, which can cause a heart attack
• Widen or bypass clogged arteries

Lifestyle Changes

Making lifestyle changes can help treat CAD. For some people, these changes may be the only treatment needed:

• Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight
• Quit smoking, if you smoke
• Exercise, as directed by your doctor
• Lose weight, if you are overweight or obese
• Reduce stress

Medicines

In addition to making lifestyle changes, medicines may be needed to treat CAD. Some medicines decrease the workload on the heart and relieve symptoms of CAD. Others decrease the chance of having a heart attack or dying suddenly and prevent or delay the need for a special procedure (for example, angioplasty or bypass surgery).

Several types of medicine are commonly used to treat CAD.

• Cholesterol-lowering medicines help to reduce your cholesterol to a doctor-recommended level.
• Anticoagulants (AN-te-ko-AG-u-lant) help to prevent clots from forming in your arteries and blocking blood flow.
• Aspirin, and other antiplatelet medicines, help to prevent clots from forming in your arteries and blocking blood flow. Blood contains small cells called platelets which clump together to form clots. Antiplatelet medicines reduce the ability of platelets to form clots. Aspirin may not be appropriate for some people because it increases the risk of bleeding. Discuss the benefits and risks with your doctor before starting aspirin therapy.
• ACE (angiotensin-converting enzyme) inhibitors help to lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack and heart failure.
• Beta blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart. Beta blockers are used to relieve angina and may also reduce the risk of a future heart attack.
• Calcium channel blockers relax blood vessels (arteries and veins) and lower your blood pressure. These medicines can reduce your heart's workload, help widen coronary arteries, and relieve and control angina.
• Nitroglycerin widens the coronary arteries, increasing blood flow to the heart muscle and relieving chest pain.
• Long-acting nitrates are similar to nitroglycerin but are longer acting and can limit the occurrence of chest pain when used regularly over a long period.
• Glycoprotein IIb-IIIa inhibitors are very strong antiplatelet medicines that are used in hospitals during and after angioplasty or to treat angina.
• Thrombolytic agents dissolve the clots that can occur during a heart attack. Thrombolytic therapy is administered in the hospital. Thrombolytic therapy and other treatments for heart attack are more effective the sooner they are given after a heart attack starts. You need to get to a hospital as soon as possible if you think you are having a heart attack.

Special Procedures

• Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a device called a stent is placed in the artery to keep the artery propped open after the procedure.
• Coronary artery bypass surgery. In this procedure arteries or veins from other areas in your body are used to bypass your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Angioplasty or bypass surgery may be used to treat CAD if:

• Medicines and lifestyle changes have not improved your symptoms.
• Your symptoms are getting worse.

Some people may need to have angioplasty or bypass surgery on an emergency basis during a heart attack to limit damage to the heart.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after bypass surgery, angioplasty, or a heart attack. Cardiac rehab, when combined with medicine and surgical treatments, can help you recover faster, feel better, and develop a healthier lifestyle.

Almost everyone with CAD can benefit from cardiac rehab.

Cardiac rehab often begins in the hospital after a heart attack, heart surgery, or other heart treatment. Rehab continues in an outpatient setting after you leave the hospital.

The cardiac rehab team may include:

• Doctors
  • Your family doctor
  • A heart specialist
  • A surgeon
• Nurses
• Exercise specialists
• Physical therapists and occupational therapists
• Dietitians
• Psychologists or other behavior therapists

Rehab has two parts:

• Exercise training. This helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
• Education, counseling, and training. This helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

For more information on cardiac rehab, consult "Recovering from Heart Problems Through Cardiac Rehabilitation: Patient Guide" from the Agency for Healthcare Research and Quality.