CAD caused by atherosclerosis is treated with one or more of the following treatments.
Lifestyle changes include:
Weight loss in obese patients
Diet and medications to lower high cholesterol and high blood pressure
Stress reduction techniques, such as meditation and biofeedback
Nitrates (including nitroglycerin). These medications are vasodilators. They widen the coronary arteries to increase blood flow to the heart muscle. They also widen the body's veins. This lightens the heart's workload by temporarily decreasing the volume of blood returning to the heart.
Beta-blockers. These medications decrease the heart's workload. They do this by slowing the heart rate. They also reduce the force of heart muscle contractions, especially during exercise. People who have had a heart attack should stay on a beta-blocker for life. This will reduce the risk of a second heart attack. Atenolol (Tenormin) and metoprolol (Lopressor) are beta blockers.
Aspirin. Aspirin helps to prevent blood clots from forming inside narrowed coronary arteries. It reduces the risk of heart attack in people who already have CAD. Doctors often advise people older than 50 to take a low dose of aspirin every day to help prevent a heart attack.
Calcium channel blockers. These medications may help to decrease the frequency of chest pain in patients with angina. Examples include nifedipine (Adalat, Procardia) and diltiazem (Cardizem).
Cholesterol-lowering medications. The choice of medication depends upon your cholesterol profile.
Statins reduce the risk of heart attack and death in people with CAD and those at risk of CAD. Statins lower LDL cholesterol and may raise HDL cholesterol slightly. Taking a statin regularly also helps to reduce inflammation inside plaques of atherosclerosis. This is why doctors prescribe statins for people who have signs of inflammation, even if their cholesterol levels are normal. Examples of statins include simvastatin (Zocor), pravastatin (Pravachol), atorvastatin (Lipitor), and rosuvastatin (Crestor).
Niacin lowers LDL cholesterol, raises HDL cholesterol, and also lowers triglyceride levels.
Medications called fibrates are used primarily in people with high triglyceride levels. Gemfibrozil (Lopid) and fenofibrate (Tricor, many generic versions) are fibrates.
Ezetimibe (Zetia) works within the intestine. It decreases the absorption of cholesterol from food.
Coronary artery angiography. Some people are physically limited by stable angina because of chest pain. In this case, your doctor likely will advise you to have a coronary artery angiography to look for significant blockages. This procedure is also called a cardiac catheterization.
Balloon angioplasty. When one or more significant blockages are found, the cardiologist will determine if the blockage(s) can be opened. He or she will consider a procedure called balloon angioplasty. Balloon angioplasty is also called percutaneous transluminal coronary angioplasty, or PTCA.
In balloon angioplasty, a catheter is inserted into an artery in the groin or forearm. The catheter is threaded into the blocked coronary artery. A small balloon at the catheter tip is inflated briefly to open the narrowed blood vessel.
Usually, balloon inflation is followed by the placement of a stent. A stent is a wire mesh that expands with the balloon. The wire mesh remains inside the artery to keep it open. The balloon is deflated and the catheter is removed.
Coronary artery bypass surgery (CABG). If the blockages cannot be opened with balloon angioplasty, the cardiologist will likely suggest CABG.
CABG involves grafting one or more blood vessels onto the coronary arteries. This allows blood to bypass the narrowed or blocked areas. The blood vessels to be grafted can be taken from an artery inside the chest or arm, or from a long vein in the leg.
Treating heart attack or sudden worsening of angina
The goal of treating heart attacks or sudden worsening of angina is to rapidly restore blood flow to the section of heart muscle no longer getting blood flow.
Patients immediately receive:
Medication to relieve pain
A beta-blocker to slow the heart rate and decrease the work of the heart
Aspirin combined with other medications to dissolve or inhibit blood clotting
When possible, patients are transferred to a cardiac catheterization laboratory. There, they have an immediate angiography and balloon angioplasty of the most significant blockage.
In some people with CAD, other symptoms or complications will require additional treatment. For example, medication may be needed to treat abnormal heart rhythms or low blood pressure.