Coronary Artery Disease

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:

• Coronary artery bypass surgery
• Minimally invasive heart surgery