Treatment Options
None of these treatment options "cure" coronary artery disease, remember whatever you can do for prevention is the key.
Medical therapy
Medical therapy, or using medications to enable patients to live with the disease that is present is one of the options. While there are many different invasive treatments for the management of coronary artery disease and valvular disease, occasionally the best treatment is simply medical therapy. Medications are prescribed to assist you with living with the degree of blockages you may have. You may have mild disease, in which medications are your best option. You may have severe diffuse disease in which medications are your best option. There are many forms of medical therapy. Medications commonly used may include, aspirin, coumadin, other antiplatlet medication, beta blockers, calcium channel blockers, lipid lowering agents, ace inhibitors, etc. Please contact your doctor or pharmacist for more information concerning these medications.
Invasive or interventional treatment procedures including Angioplasty, Stent, DCA, PTCRA
Depending on the size of the blockage, the area of the blockage, and the degree of other blockages present will determine the necessity or need for an interventional procedure. An angioplasty or PTCA utilizes a balloon to "push" the blockages to the side of the artery. The stent utilizes a mesh-like material to keep the area of the artery open. It is inserted utilizing a balloon catheter with the stent inlaid upon it, the stent is deployed and remains in the artery. It will adhere to the walls of the artery to keep the area open. A DCA (directional coronary athrectomy) and the PTCRA (percutaneous coronary athrectomy) both use a scraping type procedure to remove the plaque.
Coronary Artery Bypass Grafting
If the blockages are severe, multiple or in an area not easily reached by a balloon or would be made worse by a balloon, then coronary artery bypass grafting (CABG) would be recommended. The case would be reviewed by the cardiologist and the cardiovascular surgeon to determine if this would be the best treatment option. "Bypasses" are made from arteries in the chest area, or arm area or veins in the legs to "go around" the blockages.
EPS and ablation
If someone has an irregular or abnormal heartbeat (arrhythmia), they may see an electrophysiologist. After non-invasive evaluation, a EPS study may be preformed to further evaluate the electrical aspects of the heart. Symptoms are often managed by medical therapy. However, occasionally medications are intolerable or have too many side effects. If an abnormal pathway is found, and medications are not an option, then perhaps an ablation can be preformed to correct the problem. An ablation utilizes newer catheter techniques to "eliminate" the pathway. A special catheter is used to deliver radiofrequency energy to the area of the heart causing the problem. Success rates exceed 95% for correcting supraventricular tachycardias.
Implantable Cardioverter Defibrillators (ICD)
ICD's are used to stop life threatening heart rhythms. An ICD can continually monitor the rhythm and deliver an electrical shock or electrical therapy to the heart to correct fast heart rates. The device is approximately the size of a beeper and contains a battery, microprocessor and related circuits. Leads connect it to the heart and it records and stores events. It is surgically implanted, similar to a pacemaker, near the collarbone.
Pacemakers
Pacemaker can be temporary or permanent. Temporary pacemakers are placed in the hospital for short periods of time to help the heart rhythm when it slows down. Permanent pacemakers are used for several different reasons to help regular the heart rhythm. Occasionally medications are used to slow the heart down and the heart can't compensate, a pacemaker may be used to help regulate the rhythm. Other times the "natural" pacemaker may be incompetent, and the heart needs help to regulate the heart rhythm. They function similar to the ICD's but are used for slow heart beats.