Non-Invasive Treatment
Medications
Lifestyle modifications, such as diet, exercise, stress management and smoking cessation can significantly improve your heart health. But when lifestyle changes alone are not effective, it may be necessary to add medications. All of these medications can cause side effects, and should only be taken when prescribed by your doctor. A discussion of particular side effects is beyond the scope of this website.
Blood pressure lowering drugs can help control blood pressure. There are different types of high blood pressure medications:
1. Angiotensin-converting enzyme (ACE) inhibitors. These drugs expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficient. Frequently prescribed ACE inhibitors include captopril (Capoten), lisinopril (Prinivil, Zestril) and ramipril (Altace).
2. Angiotensin II receptor blockers. Angiotensin-2 (AT-2) receptor antagonists produce effects similar to those produced by ACE inhibitors. They may be better tolerated because they produce less cough. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), olmesartan (Benicar) and valsartan (Diovan).
3. Beta blockers. These drugs block the effects of adrenaline on the heart make the heart beat slower and with less force. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
4. Calcium channel blockers. Calcium channel blockers, interrupt the movement of calcium into heart and vessel cells. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem), nifedipine (Adalat, Procardia) and verapamil.
5. Diuretics. Diuretics are sometimes called “water pills” because they work in the kidney and flush excess water and sodium from the body. Frequently prescribed diuretics are furosemide (Lasix), spironolactone (Aldactone), hydrochlorothiazide (Esidrix, Hydrodiuril).
Cholesterol medications may help reduce LDL or “bad” cholesterol, decrease tryglecirdes and increase HDL or “good” cholesterol.
1. Statins decrease LDL and triglycerides, slightly increase HDL. Frequently prescribed statins are lovastatin (Mevacor), simvastatin (Zocor), atorvastatin (Lipitor), rosuvastatin (Crestor) and pravastatin (Pravachol) .
2. Cholesterol absorption inhibitors decrease LDL, slightly decrease triglycerides, and slightly increase HDL. Ezetimibe (Zetia) is the most frequently prescribed drug in this group.
3. Combination cholesterol absorption inhibitor and statin decreases LDL and triglycerides, increases HDL. Ezetimibe/simvastatin (Vytorin) is the most frequently prescribed drug in this group.
4. Niacin (vitamin B-3, nicotinic acid) increases HDL substantially and decreases LDL and triglycerides,. The commonly prescribed drugs are prescription niacin (Niaspan) and nonprescription niacin (Slo-Niacin ).
5. Combination statin and niacin decreases LDL and triglycerides, increases HDL. The niacin/lovastatin (Advicor) is the most frequently prescribed drug in this group.
6. Bile acid binding resins decrease LDL. Frequently prescribed medications are colestipol (Colestid), cholestyramine(Questran) and colesevelam (Welchol).
7. Fibrates decrease triglycerides and increase HDL. Frequently prescribed medications are gemfibrozil(Lopid) and fenofibrate (TriCor).
Anticoagulants (blood-thinners)
Many people with various forms of heart disease (e.g. atrial fibrillation, artificial heart valves, pulmonary emboli, stents) need to take blood-thinners to prevent blood clots forming in the heart or blood vessels. Anticoagulants are usually given by mouth, but can also be given by vein (intravenous) or by injecting right under the skin.
1. Anticoagulants given by mouth (orally) decrease the clotting tendency by interfering with platelets or blocking the body’s production of clotting substances. The most frequently prescribed oral blood–thinners are: aspirin, clopidorel (Plavix), warfarin (Coumadin) and Pradaxa (dabigatran etexilate).
2. Anticoagulant given by vein (intravenously) acts rapidly to thin the blood. The effect also wears off rapidly. Heparin is the intravenous anticoagulant that is often used for a short period of time when oral anticoagulants need to be stopped.
3. Anticoagulants given by injecting under the skin (subcutaneously) are heparin and low-molecular-weight heparin (Lovenox).
Invasive Treatment
Electrophysiology procedures
Catheter Ablation
Radiofrequency catheter ablation destroys or disrupts parts of the electrical pathway causing arrhythmia, providing relief for patients who may not have responded well to medications, or for whatever reason would rather not or cannot take medications. This technique has a high rate of successfully “curing” many types of arrhythmias. Radiofrequency catheters are positioned close to the abnormal electrical pathway and high frequency current is passed through them. The tip of the catheter – about the size of a pencil eraser – ablates (destroys) the site of the abnormal pathway using radio waves. Since scar tissue cannot transmit electrical impulses, after ablation, the heartbeat will only follow the normal electrical pathway. The ablation causes a very small scar or blemish within the heart and will not interfere with the normal conduction or normal function of the heart. The radiofrequency catheter is a thin, flexible wire that can be externally steered to pace, monitor and locate the site of the arrhythmia. The catheter is placed in the heart using x-ray guidance and sometimes using sound waves (ultrasound catheter imaging). The ablation catheter can also record the temperature where the catheter tip touches the heart wall when ablating or destroying the abnormal heart rhythm.
Artificial Pacemaker
Artificial pacemakers work on ‘demand’ and are used to treat slow heart rhythms. They are small sized devices ( the size of a silver dollar) that are implanted beneath the skin below the collarbone and connected to a pacing wire(s) positioned inside the heart via a vein; they deliver a small electrical impulse to stimulate the heart to beat when it is going too slow.
Implantable Cardioverter-Defibrillator ( ICD)
This is a device for people who are prone to life-threatening rapid heart rhythms. It is larger than a pacemaker ( size of a pack of cigarettes) and usually implanted beneath the skin below the collarbone. It is connected to defibrillation/pacing wire(s) positioned inside the heart via a vein. It has the capability to deliver an electric shock to the heart when it determines the heart rate is too fast, it is also capable of pacing the heart to stop it from going too slow.
Interventional cardiology procedures
Angioplasty
Percutaneous Transluminal Coronary Angioplasty, also known as angioplasty or PTCA, is a method of widening an area of an artery narrowed by fatty deposits without surgery. The procedure is similar to a cardiac catheterization. A catheter with a small, inflatable balloon on the end is guided through the artery until the balloon is positioned in the narrowed section of the artery. The balloon is inflated for up to 60 seconds, compressing the fatty deposits against the wall of the artery. The balloon may be inflated and deflated several times during the angioplasty. As a result of the angioplasty, the diameter of the blood vessel is increased, improving blood flow in the artery.
Stent placement
A coronary stent is a small, latticed, metal tube which is used to hold the coronary artery open and minimize the chance of abrupt closure after angioplasty. It is placed in the coronary artery using the same procedure as the angioplasty. The stent is typically mounted on a balloon angioplasty catheter. The stent is positioned at the narrowed area of the artery. When the balloon is inflated, the stent expands and is pressed against the vessel wall. The balloon is deflated and withdrawn, leaving the expanded metal stent permanently in place. At times, special imaging with “stent-boost” technology and intravascular ultrasound may be performed to assess the result. After a stent is placed, in addition to aspirin, patients will be prescribed another antiplatelet medication, clopidogrel, also known as Plavix. This is used to minimize the risk of clot formation in the stent while tissue grows over the stent to incorporate it into the blood vessel wall.
Open Heart Surgery
Coronary Artery Bypass Surgery (CABG)
Coronary Artery Bypass grafting or CABG is a heart surgery procedure in which blocked coronary arteries are bypassed by a blood vessel graft to restore blood flow to the heart. These bypass grafts usually come from the patient’s own arteries and veins located in the chest (mammary artery), leg (saphenous vein) or arm (radial artery). The graft leapfrogs over the blocked part of the artery to create new pathways for oxygen-rich blood to flow to the heart.
The goals of a CABG procedure are to relieve symptoms of coronary artery disease such as chest pain (angina) and /or shortness of breath (including angina), which enables the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.
The procedure consists of connecting one end of the vein or artery to the coronary artery that is blocked beyond the blockage. The other end of the vein or artery is connected to the aorta. Usually the other end of the mammary artery is left connected to the main artery from which it branches. By creating this new passageway for blood flow to the heart muscle, the graft is said to “bypass” the narrowed or blocked section of the coronary artery. Depending on the number and location of blockages, patients typically have anywhere from 1 to 5 bypasses.
The heart is accessed by cutting the patient’s breastbone with a 10-12″ long incision. A heart-lung or bypass machine is used to pump and oxygenate the blood while the surgeon works on the stopped heart. After the bypasses are complete, the heart is restarted until it is beating normally, and the patient is removed from the heart-lung machine. Stainless steel wires are used to close the sternum, and sutures or staples are used to close up the chest and leg wounds.
