Ischemic Heart Disease Treatments
Life-style modifications, such as smoking cessation and a heart-healthy diet are generally recommended.
Anti-angina medications can be prescribed to reduce oxygen consumption and/or increase cardiac blood flow.
Notice that many of these are addressed in our tutorial on
hypertension treatments.
Medications can work on the heart, blood vessels, or other targets; surgery is also an option.
Nitroglycerin, which is often administered as a tablet that dissolves under the tongue, dilates vessels and prevents spasms. Nitroglycerins can be taken as prophylaxis of or in response to an angina episode.
Beta-blockers slow the heart rate (which reduces myocardial oxygen demands).
Calcium channel blockers promote vessel dilation.
Sodium channel inhibitors, such as Ranolazine, increase myocardial relaxation (which reduces oxygen demand and increases blood flow).
ACE-inhibitors promote vessel dilation.
Statins reduce hyperlipidemia, vessel inflammation, and endothelial dysfunction.
Daily
aspirin may be prescribed for patients with elevated risk of ischemic heart disease, but benefits must be weighed against the
risk of bleeding.
Surgery: In some patients, additional procedures may be necessary to reestablish blood flow.
There are different means to coronary revascularization, which opens the coronary arteries:
Percutaneous coronary intervention, aka, angioplasty, is performed by using a catheter to place a balloon in the obstructed vessel; when the balloon is inflated, the plaque is pushed outward, widening the lumen.
A stent may be added to help keep the vessel open.
Coronary artery bypass grafting (CABG), as its name suggests, involves grafting a portion of another vessel to bypass an obstruction.
In our drawing, we show that a portion of the saphenous vein has been used to re-route blood around a blockage in the right coronary artery. The saphenous vein, radial artery, and left internal mammary artery are commonly used in this procedure.
Refractory angina refers to ischemia with angina that persists despite medical intervention; innovative treatments for these "no-option" patients are eagerly sought.
