The coronary arteries are also known as the heart arteries. They supply oxygen and nutrients to the heart muscle so that the heart is able to supply blood to the rest of the body. Heart artery disease begins at an early age when fat, proteins, calcium and plaque start to build on the artery walls. When there is a blockage in one or more of those arteries, treatment must be initiated to reduce the risk of heart attack or death.
Bypass Surgery
One of the goals of treatment is revascularization, or the restoration of blood supply to the heart muscle. One method of revascularization is coronary bypass surgery. This surgery is also called a CABG or coronary artery bypass graft. According to the Cleveland Clinic a coronary bypass surgical procedure is used when one or more arteries requires revascularization to continue to feed the heart muscle. The goal of the procedure is to relieve symptoms and can be done in combination with other procedures if necessary.
Percutaneous Coronary Intervention (PCI)
Percutaneous coronary intervention is a procedure done in the hospital for insertion of a stent or performing balloon angioplasty. According to the Cleveland Clinic these procedures are considered non-surgical because they are done without an open incision into the chest. Instead they are done through a tube or catheter that is placed into the femoral artery by a cardiologist. The physician uses imaging technology and a camera at the end of the catheter to thread the tube up the body and into the heart. According to Merck Manual Online Medical Library, this catheter is positioned to inflate a balloon at the level of the narrowed artery for several seconds. The intention is to widen the artery by compressing the atheroma. Inflation and deflation may be performed several times to get the desired effect. In order to keep the artery open, the doctor may insert a tube into the artery called a stent. This procedure is preferred over bypass surgery because it is less invasive but it may not be successful in areas of the heart not reached by the catheter.
Atherectomy
According to Baylor College of Medicine, an atherectomy is a procedure that mechanically removes the plaque from the arteries and is more commonly done in the heart arteries than in arteries in the legs or other parts of the body. During the procedure the physician clears the artery by cutting, shaving or vaporizing the plaque using a catheter that is threaded through the femoral artery. The decision to use this procedure will be based on the size and shape of the plaque, the location, if the area is hard or calcified or if there are other clots present in the artery.
Lifestyle Changes
Physicians have been recommending lifestyle changes and nutritional support to prevent heart disease but now research published in the Journal of the American Medical Association, "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease," proved that rigorous lifestyle changes resulted in regression of coronary blockages over a five year period. This lowered the risk of heart attack and stroke in the participants of the study.
Medications
Coronary artery blockages cause pain in the heart when the oxygen demand on the muscle exceeds the amount of oxygen it can receive through the blocked arteries. In these cases physicians may recommend the use of nitroglycerin to help open the arterial flow and allow more oxygen supply to the heart. According to the American Heart Association, nitroglycerin relaxes the veins and arteries to reduce the amount of blood that returns to the heart and eases the workload of the heart. Other medications may be used to decrease the oxygen demand on the heart by reducing blood pressure or slowing the rate of the heart.
EECP
If you have tried all other procedures and treatments for your heart artery blockage and had very little success, physicians may recommend an enhanced external counterpulsation (EECP) to stimulate the opening of the blockage or form new small branches of blood vessels to feed the area of the heart that has low blood flow due to the artery blockage. According to the Cleveland Clinic this is a non-invasive procedure that is used when you have chronic blockages that aren't relieved by nitroglycerin and no longer qualify for open procedures such as bypass surgery or angioplasty.
References
- Cleveland Clinic: Coronary Artery Disease: Overview
- Merck Manual Online Medicine Library: Coronary Artery Disease
- Baylor College of Medicine: Atherectomy
- Journal of the American Medical Association; "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease"; D. Ornish, LW Scherwitz, JH Billings; December 1998
- American Heart Association: Angina Pectoris Treatments
