How Is Coronary Heart Disease Treated?

Coronary Heart Disease (CHD) is treated in a number of ways, depending on the seriousness of the disease. For many people, CHD is managed with lifestyle changes and medications. Others with severe CHD may need surgery. In any case, once CHD develops, it requires lifelong management.

What kind of lifestyle changes can help a person with CHD?

If you know that you have CHD, changing your diet to one low in fat, especially saturated fat, and cholesterol will help reduce high blood cholesterol, a primary cause of atherosclerosis. In fact, it is even more important to keep your cholesterol low after a heart attack to help lower your risk of having another one. Eating less fat should also help you lose weight. If you are overweight, losing weight can help lower blood cholesterol and is the most effective lifestyle way to reduce high blood pressure, another risk factor for atherosclerosis and heart disease.

People with CHD can also benefit from exercise. Recent research has shown that even moderate amounts of physical activity are associated with lower death rates from CHD. However, people with severe CHD may have to restrict their exercise somewhat. If you have CHD, check with your doctor to find out what kinds of exercise are best for you.

Smoking is one of the three major risk factors for CHD. Quitting smoking dramatically lowers the risk of a heart attack and also reduces the risk of a second heart attack in people who have already had one.

What medications are used to treat coronary heart disease?

Ask your doctor which medication you are taking, what it does, and whether there are any side effects. Knowing more about this will help you stick to the schedule that has been prescribed for you.

What types of surgery are used to treat CHD?

Coronary angioplasty or balloon angioplasty begins with a procedure similar to that described under angiography. However, the catheter positioned in the narrowed coronary artery has a tiny balloon at its tip. The balloon is inflated and deflated to stretch or break open the narrowing and improve the passage for blood flow. The balloon-tipped catheter is then removed.

Strictly speaking, angioplasty is not surgery. It is done while the patient is awake and may last 1 to 2 hours. If angioplasty does not widen the artery or if complications occur, bypass surgery may be needed.

In a coronary artery bypass operation, a blood vessel, usually taken from the leg or chest, is grafted onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, a bypass can be done on each. The blood can then go around the obstruction to supply the heart with enough blood to relieve chest pain.

Bypass surgery relieves symptoms of heart disease but does not cure it. Usually you will need to make a number of changes in your lifestyle after the operation. If your normal lifestyle includes smoking, a high-fat diet, or no exercise, changes are advised.

Several experimental catheter-surgical procedures for unblocking coronary arteries are under study; their safety and effectiveness have not yet been established. They include:

• Atherectomy, a procedure in which surgeons shave off thin strips of the plaque blocking the artery and remove these strips.

• Laser angioplasty; instead of using a balloon to open up the blocked artery, doctors insert a catheter with a laser tip that burns or breaks down the plaque.

• Insertion of a stent, a metal coil that can be permanently implanted in a narrowed part of an artery to keep it propped open.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.