Depending on the stage of the disease, the following measures can be considered and applied individually or in combination:
- Control of risk factors
- Medication
- Dilatation of coronary artery stenosis by special cardiac catheters.
- Bypass surgery
Control of risk factors
The basis of any treatment for coronary artery disease is the consistent control of risk factors to prevent, if possible, the progression of the disease and, in the most favorable case, to achieve regression of calcification in the heart. Specifically, this means:
- Weight regulation in case of overweight
- Abstinence from alcohol and nicotine
- Dietary measures for diabetes
- Medical treatment of dyslipidemia or gout.
- Reduction of psychological stress factors
- Sufficient physical activity
If the described measures and, if necessary, the treatment of the other diseases are not enough, supportive heart medication is prescribed. Also after a heart attack follows treatment with tablets to adjust blood pressure, improve blood flow and help the weakened heart muscle to work.
Surgery for coronary artery disease
Direct interventions on the coronary arteries for chronic circulatory disorders or acute myocardial infarction are possible during cardiac catheterization. Using special inflatable balloons at the tip of cardiac catheters inserted into the coronary vessels themselves, individual constrictions can be dilated, thereby normalizing blood flow. Unfortunately, in about 20 to 30 percent of primarily successfully treated cases, new narrowings (restenosis) occur at the same site, but these can be dilated again by balloon catheters. To reduce the high risk of re-narrowing, stents are often used – expandable, mesh-like tubes made of stainless steel that keep the vessel open. Some of these also slowly release medication. If there is severe calcification in all the major coronary arteries, the only option in some cases is bypass surgery. In this major heart surgery, veins taken from other parts of the patient’s body (usually the lower leg) are sewn as vascular bridges over the narrowed coronary arteries. Because of the increasing surgical risk, repeat bypass surgery is performed only in a few isolated cases when the primary bypasses are not functioning properly.
Treatment of complications
In keeping with the complex manifestations of coronary artery disease, chronic sequelae of circulatory disturbances of the myocardium or of past myocardial infarctions also require special treatment. As a consequence of acute or chronic circulatory disturbances, patients with coronary artery disease may experience a wide variety of arrhythmias, which may be associated with a heart rhythm that is too slow or too fast.
- Chronic, recurrent arrhythmias from the ventricles, the development of which is favored by infarct scars, represent a particular problem in this regard. Since, according to current knowledge, a one hundred percent safe drug therapy of these cardiac arrhythmias is unfortunately not possible, implantable automatic defibrillators the size of a cigarette case have been developed since the mid-1980s, which are inserted under the chest muscle to the left above the heart. Although these do not prevent arrhythmias, they can effectively treat them by delivering an electric shock in an emergency.
- Heart failure after one or more heart attacks is usually treated with medication, and in severe cases, heart transplantation.
- Circulatory dysfunction of the heart valves requires drug treatment or surgical replacement of the damaged valve by artificial valve prostheses.
- If acute or chronic circulatory disorders of the heart muscle, coagulation disorders or blood clots carried into the coronary vessels are present, blood-thinning drugs must be taken for life.
Preventive measures
The best cure for a disease is known to be its prevention.In the case of coronary heart disease in particular, there are a whole range of possibilities for significantly reducing the likelihood of developing the disease by controlling individual risk factors, as described above. Above all, it is important to develop an awareness of the fact that our modern, sedentary lifestyle and our Western dietary habits are extremely conducive to vascular disease in general and coronary heart disease in particular. If risk factors such as a genetic burden exist, special attention should be paid to additional preventable or treatable risks.
