Medical Management of Coronary Artery Disease
Treatment of coronary artery disease is aimed at controlling symptoms and slowing or stopping the progression of disease. The method of treatment is based on many factors determined by your symptoms, a physical exam, and diagnostic testing. In many cases, if the blockage is less than 70 percent and not severely limiting blood flow, medications may be the first line of treatment.
Take your medications
Medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The medications you are prescribed depend on you and your specific heart problem. Check the drug search to find out more about your medications.
It is important to know:
- the names of your medications
- what they are for
- how often and at what times to take your medications
Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.
Nitroglycerin is the most common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body. This combination of effects decreases the amount of work for the heart.
Nitroglycerin comes in tablet or spray form. If you have angina, it is important that you keep this medication with you at all times.
- Nitroglycerin must be kept in a dark container.
- Keep it away from heat or moisture.
- Check the expiration date on the container.
- Once the container is opened, it must be replaced every 6 months.
If Angina Occurs...
If you have been prescribed nitroglycerin and experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 911 to get emergency help.
For patients diagnosed with chronic stable angina:If you experience angina, take one nitroglycerin tablet and let it dissolve under your tongue, repeating every 5 minutes for up to 3 tablets spanning 15 minutes. If you still have angina after taking 3 doses of nitroglycerin, call 911 to get emergency help.
Reference: ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology, 2007. 50(7):1-157.
Use of Aspirin with unstable chest pain: After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one full (325 mg) aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms.
Do not drive yourself to the hospital. In many cases, the emergency personnel can begin to give you heart-saving care right away.
To prevent damage to your heart muscle, do not delay seeking medical treatment.
Long term medications used to treat Coronary Artery Disease
The following medications are commonly prescribed for long term care in patients with coronary artery disease. Your doctor will determine if they are the right medications for you.
- Aspirin - is often used to prevent blood clots forming in the heart arteries in patients with coronary artery disease. Aspirin has been shown to improve survival after a heart attack. Learn about the risks and benefits of aspirin therapy.
- Beta blockers - are a class of medications that relax the blood vessels and slow the heart rate. It thereby improves blood flow to the heart, decreases blood pressure and symptoms of angina, and has been shown to improve survival after a heart attack.
- Ranolazine (Ranexa) is a medication used to treat chronic angina. It works by improving blood flow to the heart and decreases the occurrence of angina attacks. It is used in combination with other medications.
- Ace inhibitors - are given to patients if they have heart failure, or their heart muscle is not pumping as well as it should. Ace inhibitors have been shown to improve survival after a heart attack.
- Lipid management - is essential for all patients with coronary artery disease who have higher than normal blood lipid levels.
- Learn more about blood lipid levels.
- Learn more about statins.
Modify Risk Factors
Risk factors are traits related to the development and progression of heart disease. By decreasing your risk factors, you can improve your long term survival and quality of life.
Risk factors can be divided into:
- Non-modifiable risk factors - risk factors you cannot change
- Modifiable risk factors - those you can change
Non-modifiable Risk Factors
- Male gender. The risk of heart attack is greater in men than in women, and men have heart attacks earlier in life than women. However, at age 70 and beyond, men and women are equally at risk.
- Advanced age. Coronary artery disease is more likely to occur as you get older, especially after age 65.
- Family history of heart disease. If your parents have heart disease (especially if they were diagnosed with heart disease before age 50), you have an increased risk of developing it.
These help define your basic likelihood for developing heart disease. If you have any non-modifiable risk factors, it is even more important to work on the risk factors you can change:
Modifiable Risk Factors
Stop cigarette smoking and the use of tobacco products
Smoking is directly related to an increased risk of heart attack and its complications. If you smoke, ask your doctor about counseling, nicotine replacement medications and programs to help you quit. You and your family should try to avoid second hand smoke.
Lower high blood cholesterol
A high-fat diet can contribute to increased fat in your blood. Ask your doctor to have a measurement of your fasting lipid measurement. Follow a low-fat, low-cholesterol eating plan. When proper eating does not control your cholesterol levels, your doctor may prescribe medications. Most patients with coronary artery disease should target a LDL cholesterol less than 70 - 100 mg/dl and an HDL more than 40 mg/dl.
Control high blood pressure
High blood pressure can damage the lining of your coronary arteries and lead to coronary artery disease. Check your blood pressure on a regular basis. Most patients with coronary artery disease should target a systolic blood pressure of less than 130 mm Hg. A healthy diet, exercise, medications and controlling sodium in your diet can help control high blood pressure.
Maintain tight diabetes control
High blood sugars are linked to the progression of coronary artery disease. If you have diabetes, it is important to maintain a HbA1c less than 7 percent. You can control high blood sugar through monitoring blood sugars, diet, exercise, and medications.
Follow a regular exercise plan
A regular exercise program helps to regain or maintain your energy level, lower cholesterol, manage weight, control diabetes and relieve stress. Check with your doctor first before beginning an exercise program. if safe, 30 minutes per day of sustained aerobic exercise is recommended.
Achieve and maintain your ideal body weight
Obesity is defined as being very overweight with a body mass index (BMI) of greater than 30. When you are very overweight, your heart has to do more work, and you are at increased risk of high blood pressure, high cholesterol levels and diabetes. Ask your doctor what your ideal weight should be. A healthy diet and exercise program aimed at weight loss can help improve your health.
Control Stress and Anger
Uncontrolled stress or anger is linked to increased coronary artery disease risk. You may need to learn skills such as time management, relaxation, or yoga to help lower your stress levels.
Eat a diet low in saturated fat and cholesterol
Ask your doctor, based on your lipid results, how strict your diet should be. Most people should eat a low fat diet (less than 7 percent of calories from saturated fat). A registered dietitian is a good source for dietary information.
Ask your doctor about new risk factors
New markers, such as high-sensitivity c-reactive protein, have been linked to an increased risk for heart disease. This can be determined by a blood test. Ask your doctor about new tests to screen for heart disease risk.
Your risk for heart disease increases with each risk factor you have and the length of time you have had them. Do not take lifestyle changes lightly. These steps are important to decrease your risk for plaque development and future heart attacks. Eliminate as many risk factors as possible and increase your chances of good health. It is up to you!
For many people with coronary artery disease, a cardiac rehabilitation program provides an excellent opportunity to begin an exercise program, learn about your heart disease, and learn strategies to change your lifestyle to prevent further progression of your disease. Your family doctor can give you information about programs in your local area (cardiac rehabilitation is covered by most insurance companies) or you may go to the American Heart Association* website to search for a program, or call the Cardiac Prevention and Rehabilitation program at the Cleveland Clinic Foundation 216.444.9353.
When medications and lifestyle changes are not able to control symptoms or the narrowing progresses to a point that the heart muscle is at risk for damage, interventional procedures such as angioplasty and stents or surgery may be required to treat your heart disease. In either case, lifestyle modification and medications, will be a part of your lifelong program of disease management.
References and Resources
Reviewed by Dr. Curtis Rimmerman and Dr. Stephen Ellis
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