Treating Coronary Artery Disease

Nitroglycerin

This medicine is usually given during an attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments.

Blood-Thinning Medications

A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily.

• Warfarin (Coumadin)
• Ticlopidine (Ticlid)
• Clopidogrel (Plavix)

Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors

These may help prevent angina. In some cases, they may lower the risk of heart attack.

Medications to Lower Cholesterol

These medications may prevent the progression of CAD. They may even improve existing disease.

Evidence shows that lowering cholesterol has a positive effect on prevention of CAD events.

Revascularization

Patients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:

• Percutaneous coronary interventions (PCI)-such as balloon angioplasty , in some cases, a wire mesh stent is placed to hold the artery open
• Coronary artery bypass grafting (CABG) -segments of vessels are taken from other areas of the body and are sewn into the heart arteries to reroute blood flow around blockages

Some studies have shown that CABG may be more effective than PCI. Lifestyle changes and intensive medication may also be just as effective as PCI. * ² * ¹

Options for Refractory Angina

For patients who are not candidates for revascularization procedures but have continued angina despite medication, options include:

• Enhanced external counterpulsation (EECP)-large air bags are inflated around the legs in tune with the heart beat. The patient receives 5 one-hour treatments per week for seven weeks. This has been shown to reduce angina and may improve symptom-free exercise duration.
• Transmyocardial revascularization (TMR)-surgical procedure done with laser to reduce chest pain.
• Researchers are also studying gene therapy as a possible treatment.