In the Forum
Treatment of Heart Disease
Diana Oprean Volume: 22 (18/10/2006)
Treatment for heart disease depends upon a series of factors. However, no matter what medical treatment you receive, lifestyle changes—including quitting smoking, following a heart-healthy diet, and exercising—are critical to managing heart disease. If medicine for the treatment or prevention of heart disease was prescribed to you, there are some general guidelines you should follow, such as: knowing the names, dosages and side effects of your medications and how they work. (keeping a list of your medications with you is a good idea); taking your medications as scheduledADVERTISEMENT
, at the same time every day; keeping a medicine calendar; not decreasing your medication dosage to save money; not taking any over-the-counter drugs or herbal therapies unless you ask your doctor first, as some drugs, such as antacids, salt substitutes, antihistamines or nonsteroidal anti-inflammatory agents can worsen heart failure symptoms; before any surgery, telling the doctor or what medications you are taking.
ACE Inhibitors (angiotensin converting enzyme inhibitors) are medications that widen or dilate your blood vessels to improve the amount of blood your heart pumps and lower blood pressure. ACE inhibitors also increase blood flow, which helps to decrease the amount of work your heart has to do. You may be prescribed ACE inhibitors for the treatment of high blood pressure, heart failure, myocardial infarction, diabetes, heart disease prevention. Pregnant women are advised against taking ACE inhibitors.Angiotensin II Receptor Blockers (ARBs) have the same effects as ACE inhibitors, but work by a different mechanism. They are generally prescribed only when you cannot tolerate an ACE inhibitor.
Antiarrhythmics are used to treat abnormal heart rhythms. There are many types of antiarrhythmics, as well as other types of heart medications that can be used to treat arrhythmias, including Beta-blockers and Calcium channel blockers. Because these medications do not cure arrhythmias, only control them, you may have to take them for life.
Antiplatelet Drugs prevent the formation of blood clots. Aspirin is the most common antiplatelet drug. Antiplatelets may be prescribed for patients with coronary artery disease, heart attack, angina, stroke, transient ischemic attacks, peripheral artery disease.They may also be used after angioplasty, stent placement, heart bypass surgery, and to prevent the formation of blood clots in people with atrial fibrillation.Aspirin, used as a pain reliever for more than a hundred years, has also been used to prevent and manage heart disease since the 1970’s. Aspirin benefits the heart by decreasing pain, inhibiting blood clots, reducing the risk of heart attack, of polyp recurrence in people with a history of colon polyps and even of death from all causes. People with coronary artery disease or atherosclerosis anywhere in the body particularly benefit from aspirin therapy, as well as people who have had a heart attack, people who have undergone bypass surgery or have angina, and generally people with any risk factor for heart disease, men over the age of 40 and women over the age of 50, postmenopausal women and people who have had a transient ischemic attack or ischemic stroke. It is effective in case of a heart attack, especially if taken within 30 minutes from the onset of symptoms. Among its risks, the greatest are perhaps the increase in the risk of stomach ulcer and abdominal bleeding, as well as in the risk of bleeding into the brain during stroke. Recent research indicates an appropriate dose of aspirin is between 80 and 160 mg per day. It should not be taken on an empty stomach, and it should be taken with a full glass of water with meals or after meals to prevent stomach upset.
Beta-Blocker therapy improves the heart's ability to relax, decreases the production of harmful substances produced by the body in response to heart failure and slows the heart rate. Over time, beta-blockers improve the heart's pumping ability. They may be prescribed for heart failure, high blood pressure angina, abnormal heart rhythms, heart attacks, as well as for glaucoma, migraine headaches, and hyperthyroidism.
Calcium Channel Blockers affect the movement of calcium in the cells of the heart and blood vessels. As a result, they relax blood vessels, increase the supply of blood and oxygen to the heart, and reduce its workload. They are prescribed for high blood pressure, coronary artery disease, coronary spasm, angina, abnormal heart rhythms, hypertrophic cardiomyopathy, diastolic heart failure, migraine headaches.
Thrombolytic Therapy (Clot Busters or Reperfusion Therapy) is powerful medication given in the hospital intravenously to break up blood clots. Heart attack and ischemic stroke are the two main conditions for which thrombolytic medications may be prescribed.
Digoxin helps strengthen the force of the heart muscle's contractions, slows the heart rate, and improves blood circulation. It is usually prescribed to treat heart failure and atrial fibrillation.
Diuretics or "water pills" help the body eliminate unneeded water and salt through the urine. Getting rid of excess fluid makes it easier for the heart to pump and controls blood pressure. They may be prescribed with the following conditions: edema, high blood pressure, heart failure, kidney problems, liver problems, glaucoma (they reduce the pressure in the eye associated with this disease).
Inotropic therapy is used in end-stage heart failure to help relieve and control heart failure symptoms. This medication is only used when other medications no longer control heart failure symptoms. It stimulates an injured or weakened heart to pump harder and it increase the force of the heart muscle's contractions. It may also speed up the heart's rhythm.
Vasodilators are used to treat heart failure and control high blood pressure by relaxing the blood vessels so blood can flow more easily through the body. Vasodilators may be prescribed for people who cannot take ACE inhibitors or angiotensin receptor blockers.
Warfarin and other blood thinners help prevent clots from forming in the blood.Blood clots can move to various parts of the body and cause serious medical problems, such as a heart attack. Warfarin will not dissolve a blood clot, but it will help it dissolve over time and will prevent other clots from forming or from becoming larger.
Treatment of heart disease may also involve surgery and other procedures. Angioplasty is a non-surgical procedure, used to open blocked heart arteries. A thin plastic tube is inserted into an artery and a catheter is passed through it and guided up to the arteries surrounding the heart. Contrast material is injected through the catheter and photographed as it moves through the heart's chambers, valves, and major vessels. Bypass Surgery can be used to give the blood a new pathway to the heart, if one of the coronary arteries is blocked. During coronary artery bypass graft surgery (CABG), a blood vessel, called a graft, is removed or redirected from one area of the body and placed around the area of narrowing to "bypass" the blockages and restore blood flow.Treatment with brachytherapy involves gamma radiation and beta radiation at a site of re-narrowing of arteries after the placement of stents. This re-narrowing (in-stent restenosis) can happen due to scar tissue that forms in response to the injury created at the site of the implantation of the stent.Malfunctioning heart valves can be repaired by surgery or non-surgically (balloon valvuloplasty).
Minimally invasive heart valve procedures are performed through smaller incisions, which reduces blood loss, trauma, and length of hospital stay. Ablation is a procedure used to treat abnormal heart rhythms. It can be performed non-surgically, by insertion of a catheter into your heart and directing energy to the heart muscle, which "disconnects" the pathway of the abnormal rhythm, or surgically, during coronary artery bypass or valve surgery. Chronic angina can be treated by enhanced external counterpulsation (EECP), which may stimulate the openings or formation of collaterals (small branches of blood vessels) to create a natural bypass around narrowed or blocked arteries that cause the angina.
EECP works by compression of the vessels in the lower limbs to increase blood flow to the heart; the waves of pressure are electronically timed, so that the blood flow is delivered at the precise time when the heart relaxes.Cardioversion is used to treat arrhythmias (irregular heart rhythms). Electrical energy is delivered to the heart muscle by a special device, in order to restore the normal rhythm. Atrial fibrillation or atrial flutter and ventricular tachycardia can be treated by cardioversion.
Transmyocardial Laser Revascularization (TMR) is used to treat inoperable heart disease in people with persistent angina that isn't relieved by any other method. It improves blood flow to areas of the heart that were not treated by angioplasty or surgery, by creating small channels in the heart muscle with the aid of a carbon dioxide (CO2) laser.Heart Transplantation is considered in cases of severe heart failure that does not respond to other therapies. The person’s diseased heart is replaced with the healthy heart of a donor. Heart transplantation may be the only solution in severe cases of: dilated cardiomyopathy, coronary artery disease with scarred heart tissue from a heart attack, or birth defects of the heart.
Cardiac Devices
Abnormal heart rhythms can also be treated by implantation of a pacemaker or of an ICD (implantable cardioverter defibrillator). A pacemaker sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm and may also be used to treat fainting spells (syncope), congestive heart failure, and hypertrophic cardiomyopathy. The ICD constantly monitors heart rate and rhythm, and when it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle, causing the heart to beat in a normal rhythm again. There are single chamber, dual chamber and biventricular pacemakers and ICD’s.The left ventricular assist device (LVAD or VAD) is a kind of mechanical heart, placed inside a person's chest, where it helps the heart do its job. It is not an artificial heart that replaces it. A person whose heart needs a rest after open-heart surgery or a person waiting for a heart transplant may benefit from it, and it may also be used to allow weakened hearts to recover.Cardiac resynchronization therapy (CRT), or biventricular pacing, is used when the right and left ventricles do not pump together, which causes the left ventricle to be unable to pump enough blood throughout the body. It uses a biventricular pacemaker, which works by sending small electrical impulses through the leads. Some of these treatment options are not suitable, however, for persons undergoing certain other types of treatment, for persons taking some medication, for persons with a certain medical condition, such as diabetes, or for pregnant women. Make sure to check with your doctor all of these aspects, as well as aspects linked to your preparation for some of the procedures.
ACE Inhibitors (angiotensin converting enzyme inhibitors) are medications that widen or dilate your blood vessels to improve the amount of blood your heart pumps and lower blood pressure. ACE inhibitors also increase blood flow, which helps to decrease the amount of work your heart has to do. You may be prescribed ACE inhibitors for the treatment of high blood pressure, heart failure, myocardial infarction, diabetes, heart disease prevention. Pregnant women are advised against taking ACE inhibitors.Angiotensin II Receptor Blockers (ARBs) have the same effects as ACE inhibitors, but work by a different mechanism. They are generally prescribed only when you cannot tolerate an ACE inhibitor.
Antiarrhythmics are used to treat abnormal heart rhythms. There are many types of antiarrhythmics, as well as other types of heart medications that can be used to treat arrhythmias, including Beta-blockers and Calcium channel blockers. Because these medications do not cure arrhythmias, only control them, you may have to take them for life.
Antiplatelet Drugs prevent the formation of blood clots. Aspirin is the most common antiplatelet drug. Antiplatelets may be prescribed for patients with coronary artery disease, heart attack, angina, stroke, transient ischemic attacks, peripheral artery disease.They may also be used after angioplasty, stent placement, heart bypass surgery, and to prevent the formation of blood clots in people with atrial fibrillation.Aspirin, used as a pain reliever for more than a hundred years, has also been used to prevent and manage heart disease since the 1970’s. Aspirin benefits the heart by decreasing pain, inhibiting blood clots, reducing the risk of heart attack, of polyp recurrence in people with a history of colon polyps and even of death from all causes. People with coronary artery disease or atherosclerosis anywhere in the body particularly benefit from aspirin therapy, as well as people who have had a heart attack, people who have undergone bypass surgery or have angina, and generally people with any risk factor for heart disease, men over the age of 40 and women over the age of 50, postmenopausal women and people who have had a transient ischemic attack or ischemic stroke. It is effective in case of a heart attack, especially if taken within 30 minutes from the onset of symptoms. Among its risks, the greatest are perhaps the increase in the risk of stomach ulcer and abdominal bleeding, as well as in the risk of bleeding into the brain during stroke. Recent research indicates an appropriate dose of aspirin is between 80 and 160 mg per day. It should not be taken on an empty stomach, and it should be taken with a full glass of water with meals or after meals to prevent stomach upset.
Beta-Blocker therapy improves the heart's ability to relax, decreases the production of harmful substances produced by the body in response to heart failure and slows the heart rate. Over time, beta-blockers improve the heart's pumping ability. They may be prescribed for heart failure, high blood pressure angina, abnormal heart rhythms, heart attacks, as well as for glaucoma, migraine headaches, and hyperthyroidism.
Calcium Channel Blockers affect the movement of calcium in the cells of the heart and blood vessels. As a result, they relax blood vessels, increase the supply of blood and oxygen to the heart, and reduce its workload. They are prescribed for high blood pressure, coronary artery disease, coronary spasm, angina, abnormal heart rhythms, hypertrophic cardiomyopathy, diastolic heart failure, migraine headaches.
Thrombolytic Therapy (Clot Busters or Reperfusion Therapy) is powerful medication given in the hospital intravenously to break up blood clots. Heart attack and ischemic stroke are the two main conditions for which thrombolytic medications may be prescribed.
Digoxin helps strengthen the force of the heart muscle's contractions, slows the heart rate, and improves blood circulation. It is usually prescribed to treat heart failure and atrial fibrillation.
Diuretics or "water pills" help the body eliminate unneeded water and salt through the urine. Getting rid of excess fluid makes it easier for the heart to pump and controls blood pressure. They may be prescribed with the following conditions: edema, high blood pressure, heart failure, kidney problems, liver problems, glaucoma (they reduce the pressure in the eye associated with this disease).
Inotropic therapy is used in end-stage heart failure to help relieve and control heart failure symptoms. This medication is only used when other medications no longer control heart failure symptoms. It stimulates an injured or weakened heart to pump harder and it increase the force of the heart muscle's contractions. It may also speed up the heart's rhythm.
Vasodilators are used to treat heart failure and control high blood pressure by relaxing the blood vessels so blood can flow more easily through the body. Vasodilators may be prescribed for people who cannot take ACE inhibitors or angiotensin receptor blockers.
Warfarin and other blood thinners help prevent clots from forming in the blood.Blood clots can move to various parts of the body and cause serious medical problems, such as a heart attack. Warfarin will not dissolve a blood clot, but it will help it dissolve over time and will prevent other clots from forming or from becoming larger.
Treatment of heart disease may also involve surgery and other procedures. Angioplasty is a non-surgical procedure, used to open blocked heart arteries. A thin plastic tube is inserted into an artery and a catheter is passed through it and guided up to the arteries surrounding the heart. Contrast material is injected through the catheter and photographed as it moves through the heart's chambers, valves, and major vessels. Bypass Surgery can be used to give the blood a new pathway to the heart, if one of the coronary arteries is blocked. During coronary artery bypass graft surgery (CABG), a blood vessel, called a graft, is removed or redirected from one area of the body and placed around the area of narrowing to "bypass" the blockages and restore blood flow.Treatment with brachytherapy involves gamma radiation and beta radiation at a site of re-narrowing of arteries after the placement of stents. This re-narrowing (in-stent restenosis) can happen due to scar tissue that forms in response to the injury created at the site of the implantation of the stent.Malfunctioning heart valves can be repaired by surgery or non-surgically (balloon valvuloplasty).
Minimally invasive heart valve procedures are performed through smaller incisions, which reduces blood loss, trauma, and length of hospital stay. Ablation is a procedure used to treat abnormal heart rhythms. It can be performed non-surgically, by insertion of a catheter into your heart and directing energy to the heart muscle, which "disconnects" the pathway of the abnormal rhythm, or surgically, during coronary artery bypass or valve surgery. Chronic angina can be treated by enhanced external counterpulsation (EECP), which may stimulate the openings or formation of collaterals (small branches of blood vessels) to create a natural bypass around narrowed or blocked arteries that cause the angina.
EECP works by compression of the vessels in the lower limbs to increase blood flow to the heart; the waves of pressure are electronically timed, so that the blood flow is delivered at the precise time when the heart relaxes.Cardioversion is used to treat arrhythmias (irregular heart rhythms). Electrical energy is delivered to the heart muscle by a special device, in order to restore the normal rhythm. Atrial fibrillation or atrial flutter and ventricular tachycardia can be treated by cardioversion.
Transmyocardial Laser Revascularization (TMR) is used to treat inoperable heart disease in people with persistent angina that isn't relieved by any other method. It improves blood flow to areas of the heart that were not treated by angioplasty or surgery, by creating small channels in the heart muscle with the aid of a carbon dioxide (CO2) laser.Heart Transplantation is considered in cases of severe heart failure that does not respond to other therapies. The person’s diseased heart is replaced with the healthy heart of a donor. Heart transplantation may be the only solution in severe cases of: dilated cardiomyopathy, coronary artery disease with scarred heart tissue from a heart attack, or birth defects of the heart.
Cardiac Devices
Abnormal heart rhythms can also be treated by implantation of a pacemaker or of an ICD (implantable cardioverter defibrillator). A pacemaker sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm and may also be used to treat fainting spells (syncope), congestive heart failure, and hypertrophic cardiomyopathy. The ICD constantly monitors heart rate and rhythm, and when it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle, causing the heart to beat in a normal rhythm again. There are single chamber, dual chamber and biventricular pacemakers and ICD’s.The left ventricular assist device (LVAD or VAD) is a kind of mechanical heart, placed inside a person's chest, where it helps the heart do its job. It is not an artificial heart that replaces it. A person whose heart needs a rest after open-heart surgery or a person waiting for a heart transplant may benefit from it, and it may also be used to allow weakened hearts to recover.Cardiac resynchronization therapy (CRT), or biventricular pacing, is used when the right and left ventricles do not pump together, which causes the left ventricle to be unable to pump enough blood throughout the body. It uses a biventricular pacemaker, which works by sending small electrical impulses through the leads. Some of these treatment options are not suitable, however, for persons undergoing certain other types of treatment, for persons taking some medication, for persons with a certain medical condition, such as diabetes, or for pregnant women. Make sure to check with your doctor all of these aspects, as well as aspects linked to your preparation for some of the procedures.
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