by Parlikar U Treatment StrategiesIn the early stages of cardiovascular disease, treatment typically focuses on lifestyle changes. These lifestyle changes are aimed at reversing, slowing, or stopping the progression of the disease. If lifestyle changes are not effective, your doctor may recommend that you take medicine. Surgery may be needed in more severe cases. Lifestyle ChangesYour doctor may recommend that you make these lifestyle changes: - Become a nonsmoker.
—If you smoke, talk to your doctor about strategies to quit. There are many options, like online programs, smoking cessation drugs, and counseling.
- Eat healthy foods.
—
Changing your diet can help reduce your risk factors, such as
high cholesterol
,
high blood pressure
, and excess body weight. Your doctor may also advise you to eat a low-fat diet and a low-sodium diet.
- Become more active.
—Even though you have been diagnosed with cardiovascular disease, exercise is still important to your overall health. Work closely with your doctor to create a safe exercise program for you.
- Drink only in moderation.
—This means drinking no more than one alcoholic beverage if you are a woman, and no more than two alcoholic beverages per day if you are a man.
- Maintain a healthy weight.—Maintaining a healthy weight can help keep your cardiovascular disease under control. If you need to lose weight, talk with your doctor, who can teach you safe strategies to lose weight.
MedicationsMedicines are often used alone or in combination to treat or control cardiovascular conditions. Talk to your doctor about side effects and possible interactions with food, herbs and supplements, and other medicines that you are taking. The following list provides information on medicines that your doctor may prescribe if you have been diagnosed with cardiovascular disease. Antiarrhythmics
These drugs work to stabilize the electrical conduction system of the heart. Your doctor will decide which type of medicine to prescribe depending on the type and severity of your
arrhythmias
, your symptoms, and your overall health.
The different classes of antiarrhythmics include: - Sodium channel blockers (eg, amiodarone, propafenone)
- Beta blockers (eg, acebutolol, propranolol)
- Action-potential prolonging agents (eg, sotalol)
- Calcium channel blockers (eg, verapamil)
Antianginals
These medicines alleviate or prevent
angina
. Antianginals does this by helping to restore the balance between the heart’s supply and demand of oxygen.
- Nitrates and nitrites (eg, nitroglycerin)
- Beta blockers (eg, acebutolol, propranolol)
- Calcium channel blockers (eg, nifedipine, amlodipine)
Anticoagulants
Anticoagulants are used to prevent
stroke
and
heart attack
in people who are at an increased risk due to heart conditions or heart surgery. Anticoagulants prevent clots from forming or inhibit existing clots from growing. But, these medicines cannot dissolve clots that already exist.
Examples of anticoagulants include: - Warfarin (eg, Coumadin)
- Heparin
Medications to Treat Heart FailureThese medicines are designed to increase the amount of blood the heart can eject with each beat.
Your doctor may prescribe one or a combination of these medicines: - Angiotensin converting enzyme (ACE) inhibitors (eg, enalapril, ramipril)
- Angiotensin receptor blockers (ARBs) (eg, candasartan, valsartan)
- Beta blockers (eg, bisoprolol, metoprolol)
- Inotropic agents (eg, digoxin, digitoxin)
- Loop diuretics (eg, furosemide, bumetanide)
Thrombolytic AgentsThrombolytic agents are used to dissolve clots that have formed in blood vessels. They are administered during heart attacks to dissolve the clot and restore blood flow to the affected heart muscle. Examples of thrombolytic agents include: - Streptokinase
- Anistreplase
Other MedicationsMost of the medicines used to reduce the risk of cardiovascular disease are also used in its treatment. These include: - High blood pressure medicine
- Cholesterol-lowering drugs
- Anti-diabetic medicine
- Antiplatelet medicine
ProceduresSurgical or nonsurgical procedures are often necessary to treat cardiovascular conditions. Some may be scheduled electively while others are performed urgently in response to a cardiovascular event or results from a diagnostic procedure that indicate a cardiovascular event is imminent. There are a range of procedures and surgeries that may be needed to treat cardiovascular disease. Abdominal Aortic Aneurysm RepairAbdominal aortic aneurysm
(AAA) is a bulge in the portion of the aorta where it passes though the abdomen carrying blood to the abdominal organs, pelvis, and legs.
Abdominal aortic aneurysm repair
, which involves removal of the blood clot in the aneurysm and repair of the aorta wall, is done when an AAA grows too large or ruptures.
In some situations, a stent (wire mesh) is inserted into the aorta to treat the aneurysm.
CardioversionCardioversion
is done to correct an abnormal heartbeat. When the arrhythmia is not imminently dangerous or uncomfortable, cardioversion can be done gradually with antiarrhythmic medicines. If your condition is less stable, prompt electrical cardioversion is necessary. This is done by delivering an electrical charge through electrodes or paddles placed on the chest. This causes a brief interruption in the heart beat, giving the conduction system a chance to reset itself.
Carotid EndarterectomyCarotid endarterectomy
is used to remove plaque from the carotid artery, which carries blood to the brain. This procedure is often done to reduce the risk of a stroke in patients who have had
transient ischemic attacks
. The artery on either side is cut open, cleaned, and repaired with sutures.
In some situations, a stent is inserted into the carotid artery to treat the blocked artery.
Coronary AngioplastyCoronary angioplasty
is used to restore blood flow in a blocked coronary artery.
It is done during a cardiac catheterization procedure in which a balloon at the tip of the catheter is quickly inflated and deflated to open the vessel. Often, a stent is inserted into the vessel to keep it from narrowing again in the future.
Coronary StentingCoronary stenting
is done along with coronary angioplasty. Once a catheter with a balloon at the tip is inserted into a blocked vessel, a stent is placed at the tip of the catheter. The balloon is inflated, opening up the blocked vessel, and also expanding the stent. The stent, which is sometimes medicated with anticoagulant medicine (blood thinners), remains in the blood vessel to prevent it from narrowing again in the future.
Coronary Artery Bypass Graft (CABG)Coronary artery bypass graft (CABG)
is used to restore blood flow to the heart, particularly if there are severe or multiple blockages in several coronary arteries. In this procedure, surgeons reroute the blood flow around the blockages by grafting vessels from another part of the body into the coronary circulation.
Femoropopliteal Bypass Surgery
Similar to a CABG procedure,
femoropopliteal bypass surgery
is used to bypass a blocked artery in the leg, restoring proper blood flow to the lower leg and foot. Doctors use a vein from another part of the body or an artificial vessel to graft around the blocked artery.
Heart Valve Replacement
During
heart valve replacement
, damaged valves (that are either too stiff to allow blood to flow freely or too leaky to keep blood flowing in one direction) are replaced with artificial or transplanted valves. Doctors do open-heart surgery to remove the damaged valve and suture in the replacement valve.
There is another type of surgery called transcatheter aortic valve replacement. This also involves replacing a damaged valve. But this is minimally invasive surgery that involves inserting the replacement valve through a small incision in the chest or through an artery in the leg. Heart-lung TransplantHeart-lung transplant
is used to remove extremely diseased and damaged lungs and heart and to replace them with healthy organs donated by someone who has died. This is most commonly done on people with severe pulmonary hypertension. During this procedure, the doctors divert the patient’s circulation to a heart-lung machine, which takes over the functions of those organs. They then remove the patient’s lungs and most of the heart and replace them with the donor lungs and heart, Finally, the surgeons connect the donor heart and lungs to the patient’s blood vessels, detach the heart-lung machine, and restore the patient’s natural circulation.
Heart Transplant
A
heart transplant
is done to replace a diseased and damaged heart with a healthy heart donated by someone who has died. It is usually reserved for patients whose
heart failure
is life-threatening and when other treatments have failed. During a heart transplant, the patient’s own circulation is rerouted to a heart-lung machine. All except the back wall of the upper chamber of the patient’s heart is removed. The donor heart is attached, connected to the patient’s blood vessels, and the heart-lung machine is disconnected.
Pacemaker Insertion
A
pacemaker insertion
is needed when the body’s natural pacemaker no longer works properly. The artificial pacemaker maintains the normal heartbeat by automatically sending electrical impulses to the heart when it detects an abnormal rhythm. It is inserted through an incision beneath the collarbone. Wires from the pacemaker are then inserted through a vein to reach the heart.
Biventricular PacemakerThis is a treatment for heart failure that uses a three-lead biventricular pacemaker. This type of pacemaker sends tiny electrical impulses to the heart muscle to coordinate (resynchronize) the pumping of the chambers of the heart, improving the heart’s pumping efficiency. Both ventricles are paced to contract at the same time. This can reduce the symptoms of heart failure. Implantable Defibrillator
An
implantable defibrillator
is similar to a pacemaker in that it is implanted to correct an abnormal heartbeat. But where a pacemaker generally corrects heartbeats that are too slow, a defibrillator corrects heartbeats that are too fast. In particular, the defibrillator intervenes with an instantaneous pulse of electricity to reset the heart beat when it detects a life-threatening arrhythmia (called
ventricular fibrillation
). The defibrillator is implanted during a minor surgical procedure.
RESOURCESAmerican Heart Association
http://www.heart.org/ National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCESCanadian Cardiovascular Society
http://www.ccs.ca/ Canadian Society for Vascular Surgery
http://www.canadianvascular.ca/
References
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JAMA
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Transcatheter aortic valve replacement. Stanford Medicine website. Available at:
http://med.stanford.edu/clinicaltrials/ctsurgery/detail.do?studyId=1263
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