Coronary Heart Disease (Atherosclerosis)
Things you can do -
If you’re diagnosed with CHD, you can reduce your risk of further damage by making small changes in your lifestyle. Some of the things you can do are:
- Avoid tobacco - Quitting smoking will reduce your risk of CHD to a great extent.
- Eat right - Avoid consuming trans fats found in stick margarine, fried foods, snacks, junk foods. Also, limit the amount of saturated fat and cholesterol you consume by reducing your intake of red meat, whole dairy products and eggs. Eat plenty of fish, whole grain products, fruits and vegetables and use olive oil or canola oil for cooking. Cut down on salt. If you can drink responsibly, one or two drinks a day should be fine.
- Stay active - It is very important to include small amount of exercise such as walking, biking or any other form of moderate exercise for about 30 minutes in your daily routine. Do not attempt any heavy form of exercise; always consult your doctor on the type of exercises you can undertake.
- Keep your weight under control - Try to cut down on the calories you eat and boost the calories you burn with exercise.
- Reduce stress - Learn to relax and keep your life as stress-free as possible. Your doctor can help you to learn ways to cope with stress.
Apart from making changes to your lifestyle, you also need to take medications and supplements. The various options, depending upon your condition, are:
- Supplements - Fish oil capsules are beneficial for CHD patients to get 1 gram of omega-3 fats each day.
- Anti-clotting drugs - Aspirin can prevent artery-blocking blood clots. Only 81 mg or baby aspirin is sufficient for this. If you have ulcers, bleeding or allergy, you should not take this or get it in the enteric-coated form. Some of the other anti-clotting drugs your doctor might suggest are clopidogrel or warfarin.
- Nitrates - Nitrates are used to relax the muscles in the walls of the arteries to widen the channels. Nitroglycerin, another form of nitrate used for immediate relief, is put under the tongue in the form of tablets or sprays to relieve angina. Long-acting nitrate pills or patches can be used to prevent angina. The side effects of this medicine include headache and light-headedness. It’s important to note that men who use nitrates cannot take pills for erectile dysfunction.
- Beta-blockers - These medications widen the arteries, slow the heart rate and lower the blood pressure. Anyone who has CHD should take beta-blockers to prevent repeat attacks. They also help prevent angina in patients with stable CHD. The side effects of the drug include slow pulse, low blood pressure, wheezing, fatigue, and cold hands and feet.
- Angiotension (converting enzyme inhibitors, ACEIs, and Angiotension-receptor blockers, ARBs) - These medications widen the arteries and lower the blood pressure. They also help the heart heal after heart attacks and protect the kidneys of patients with diabetes. It is a must for almost every patient to take an ACEI after a heart attack. The side effects of this drug include cough, low blood pressure and dizziness, and high potassium levels. ARBs are prescribed for patients who cannot take ACEIs.
- Calcium-channel blockers - These drugs also act by widening the arteries and lowering the blood pressure. They can also help prevent angina but are less desirable after a heart attack in patients with impaired heart function. The side effects are dizziness, low blood pressure, fluid retention and constipation.
- Cholesterol-lowering drugs - These drugs help you to get cholesterol levels under control and maintain them at the recommended levels. The ideal level of LDL cholesterol in patients with mild CHD should be 100mg/dL or less whereas for patients with unstable or severe CHD it should be 70 mg/dL or less. Some of the common drugs used are statins, niacin, fibrates, ezetimibe and the resins.
For detailed understanding about each medication read our article Medications For Coronary Artery Disease
Operations and Surgical Options -
Most CHD patients benefit from the medications, lifestyle changes and procedures such as revascularization (restoring blood flow to the heart), but in case of emergencies other treatment methods are involved such as:
- Angioplasty - A thin catheter (tube) is inserted into the narrowed artery and once it’s in place a tiny balloon is inflated to compress the plaque and open the artery. In most cases, a fine wire mesh or stent is introduced through the catheter and expanded in the affected area to keep it open. The procedure is performed in special cardiac catheter labs without general anesthesia.
- Coronary artery bypass graft (CABG) - It is a procedure where the cardiac surgeons remove a small length of a healthy vein or artery from the patient, then splice it to a coronary artery to push blood around the blockage. As this process involves some amount of grafting, general anesthesia is given along with a heart-lung machine.
- Heart transplant - In a small number of cases, when all the above-mentioned medications and procedures are not effective, heart transplant may be necessary. A heart transplant involves replacing a heart that’s damaged or isn’t working properly with a healthy donor heart.