What are the treatments
for heart disease?

Medication

Medication will be prescribed if lifestyle changes do not improve sugar or cholesterol levels, blood pressure and other symptoms. Medication that may be prescribed for CAD can help do the following:

  • Reduce the heart’s workload and relieve symptoms
  • Decrease the chance of having a heart attack
  • Lower cholesterol and blood pressure
  • Prevent blood clots
  • Prevent or delay the need for a procedure or surgery

Medicines used to treat CAD include anticoagulants, also called blood thinners; aspirin and other anticlotting medicines; ACE inhibitors; beta blockers; calcium channel blockers; nitroglycerin; glycoprotein IIb-IIIa; statins; fish oil and other supplements high in omega-3 fatty acids.

In some cases, coronary intervention may be required. It can be a bypass surgery or a minimally invasive procedure.

Coronary artery bypass graft surgery (CABG)

CABG is the most common type of open-heart surgery and is performed by doctors known as cardiothoracic surgeons.

The CABG is a treatment option if the heart is not pumping blood effectively as a result of severe blockages, where multiple vessels are involved or, in case of challenging anatomy that makes PCI an unsuitable option. In these cases, CABG may work better than any other types of treatment.

Coronary Angioplasty (Percutaneous Coronary Intervention)

Angioplasty/stenting – also known as percutaneous coronary intervention (PCI) – is a nonsurgical procedure that opens blocked or narrow coronary arteries, thus improving blood flow to the heart.

During this procedure, the doctor inserts a long, thin tube (catheter) into the narrowed part of the artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against the artery walls.

A stent (a small metal mesh tube) may be placed in a coronary artery to help keep it open. Currently, there are different types of stent available, namely Dual Therapy Stent, Bioresorbable Vascular Scaffold, Bio-engineered Stent, Drug Eluting Stent and Bare Metal Stent.

The Drug Eluting Stent (DES) is the most common used stent in PCI procedure. The stent may have a carrier for the drug, usually a polymer, that may be permanent or biodegradable. The polymer carries a drug that minimizes cell growth after stent implantation reducing the occurrence of vessel re-narrowing.

The Dual Therapy DES has a bio-engineered stent surface that can accelerate healing and therefore reduce the risk of stent thrombosis after stent implantation. As such, the patient may be able to stop the DAPT (Dual Antiplatelet Therapy), namely Aspirin and Plavix, at shorter duration if necessary, as advised by the physician.

What happens during PCI?

A small incision or cut is made in the skin over a blood vessel in the leg, arm or wrist through which a catheter is threaded and the procedure performed. The procedure can take from 30 minutes to several hours, depending on the individual case (number of blockages or complexity, etc).

PCI is performed by a cardiologist and a team of cardiovascular nurses and technicians in a special operating room called a cardiac catheterization laboratory, often referred to as a cath lab.

During the procedure, the patient is sedated but awake and receives fluids and blood-thinning medications (anti-coagulants) through an IV catheter.

Here’s what happens:

  • After numbing the skin, a small needle is used to access an artery in the leg or arm and a small cut is made in the skin.
  • The doctor will insert a thin guide wire followed by a catheter into the artery and thread from the incision area up to the blockage in the heart.
  • A small amount of dye is injected through the catheter to help the doctor look at the blockage on X-ray images called angiograms.

A small balloon at the end of the catheter is inflated, widening the blocked artery. After the artery is stretched, the balloon is deflated and removed. The doctor might inflate and deflate the balloon several times before it is removed, which stretches the artery a bit more each time.

Stent placement

  • Generally, the narrowed artery will be opened by a balloon (or atherectomy device if it has a lot of calcium) before a stent is implanted.  The stent provides a scaffold to the vessel keeping the vessel open for a longer period.
  • The stent is mounted on a balloon catheter. It is tracked through the artery to the narrowed segment/blockage.
  • At the blockage, the stent mounted on the balloon is inflated. The expanded stent is implanted and serves as a scaffold inside the artery.
  • The implanted stent will keep the artery open, improving blood flow to the heart.
  • The balloon catheter will then be removed. Images (angiography) will be taken to determine the improved blood flow and the procedure is done.

The doctor will prescribe DAPT (Dual Anti-Platelet Therapy) which are ‘blood-thinning’ medications called anti-coagulants. The patient must adhere to the medication regimen to avoid stent thrombosis.

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Awareness after
Treatment

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