This section gives an overview of the types of medical treatment available. Your doctor will advise on the most appropriate, taking into account medical history, symptoms and test results.
The aim of treatment is to restore blood supply to the heart as quickly as possible.
Blood thinning
The best way to restore blood to the heart is to dissolve the blood clot in the artery (thrombolysis). This is done by administering a blood thinning agent such as soluble aspirin. This thins the blood relatively quickly by reducing the ability of platelets to stick together. It is known as an antiplatelet agent.
Aspirin has the drawback that it irritates the gastric mucosa; this effect is reduced when it is in soluble form, together with calcium carbonate and citric acid. Treatment with aspirin must be ceased before any surgery, to stop the anti-platelet effect.
Nitrate drugs
Nitrate drugs are used to treat angina attacks. They work by relaxing arteries and veins so that the blood supply to the heart is improved, enabling the organ to reduce its workload. Short-acting nitrate drugs such as GTN sprays can relieve the symptoms of angina within a couple of minutes. Patches applied to the skin can be used as a long-acting form, but these cannot provide 24-hour protection as the body learns to tolerate the drug. A nitrate-free interval is required.
Anti-coagulants
To prevent blood clotting, an anti-coagulant such as warfarin will be prescribed. Your doctor will instruct you how to take the medicine. Anti-coagulants can interact with other medicines, nutrients and herbs, so care must be taken.
Preventative medication
To prevent a reoccurrence of the symptoms of heart disease, preventive medication is required.
Beta-blockers operate by slowing the heart rate, reducing the force of heart-muscle contractions so reducing the strain on the heart. They may need to be taken for life.
Calcium channel-blockers, such as diltiazem, lessen the work of the heart in pumping and reduce pressure of blood flow. They also act on blood vessels, causing them to relax.
Medications to reduce blood pressure and lipids
There are appropriate medications for the control of lipid levels and blood pressure, two of the risk factors of heart disease. Beta-blockers and calcium channel-blockers are used to treat high blood pressure as well as angina. In addition, ACE inhibitors are a group of drugs used to treat hypertension. Statins are cholesterol-lowering drugs.
Surgical treatment
In more severe cases, surgery is required, which ranges from insertion of a balloon catheter through to a full heart transplant. Angioplasty and coronary bypass may be required when the symptoms of angina cannot be controlled effectively by medication.
Surgical procedures improve blood supply to the heart and are preceded by a coronary arteriogram to locate the blocked site. The arteriogram involves injecting a dye into the arteries, which are then clearly seen on X-ray.
| Angioplasty
Patients may require an angioplasty which involves inserting a small balloon catheter into the artery in the leg or arm, under local anaesthetic. The guiding wire is threaded up through the coronary artery. The balloon is then inflated at the site of the blockage, pushing away the clot and plaque and widening the artery, restoring normal circulation to the heart. Coronary bypass (CABG)
This operation involves dissecting veins from the thigh and leg, to be used to bypass the affected area. One end of the vein is stitched into the aorta and the lower end is attached to the coronary artery just beyond the clot obstruction. Pacemaker
When the heart becomes substantially diseased or damaged, an artificial pacemaker can be fitted, which will send out electrical currents to stimulate the heart. The device fits under the skin on the right side just below the shoulder. The technology of pacemakers continues to improve. They can now be programmed to automatically speed up heart rate during exercise. Heart transplant
The replacement of the entire heart. |
Most patients admitted to a coronary care unit for treatment will spend several days there, enabling careful monitoring. When the time is right for a patient to go home, vigorous exertion must be avoided. It can take weeks to return to normal activity depending on the extent of damage.
A knowledge of medical treatment is important, but a great deal of ongoing therapeutic treatment is for ourselves to administer. Diet, exercise, cessation of smoking and alcohol in moderation all form part of what we can do to help ourselves. See the Diet and Exercise sections for more information.
20/05/2009