Treatment options for coronary artery disease - An overview
Dateline: 07/27/97
If you have read my articles over the past few weeks, you'll have a fair knowledge of what coronary arteries are, how atherosclerosis narrows them, and how doctors detect this disease. Today's article will introduce you to the different treatment options that are available to deal with narrow diseased coronaries.
PRINCIPLES OF TREATMENT
Coronary artery blocks result in a reduced blood flow to the heart muscle, which in turn reduces the heart's efficiency as a muscular pump. Treatment of this condition involves methods to increase blood flow to involved parts of the heart muscle. This can be done by medical therapy, surgery, or catheter based interventions.
MEDICAL TREATMENT OF CORONARY ARTERY DISEASE
The aims of medical therapy of coronary atherosclerosis are:
- Prevent progression of disease
- Reduce heart muscle requirement of oxygen and nutrients
- Increase coronary artery blood flow
Disease progression is arrested by controlling risk factors like smoking, obesity and exercise lack. Heart muscle requirements are brought down by controlling high blood pressure, and by reducing the work of the heart by using drugs called beta blockers. Coronary blood flow can be increased by administering medicines that dilate the coronary arteries, like nitrates and calcium channel blockers.
SURGICAL TREATMENT OF CORONARY ARTERY DISEASE
Surgery is required in some cases of coronary atherosclerosis, and attacks the problem more directly. If a particular coronary artery is blocked by disease, the surgeon places a bypass graft (using a conduit like the patient's own veins or arteries from elsewhere in the body) connecting the aorta to the distant artery beyond the block. Blood now flows from the aorta, through the bypass graft and into the coronary artery beyond the area of disease, supplying the heart muscle oxygen and nutrients. This is done by an open heart operation called Coronary Artery Bypass Grafting (CABG).
CATHETER BASED TREATMENT OF CORONARY ARTERY DISEASE
To avoid the trauma of surgery, cardiologists have devised an alternative method to treat coronary disease, by using catheters. A catheter is a special device made of plastic, that is inserted through a needle stick in the groin or forearm into an artery. A balloon catheter is a modified one where a small balloon is located near the tip. The catheter is manipulated into the aorta, and then into the coronary artery. It is positioned across the area where the artery is blocked, and the balloon at the tip is inflated. As it blows up, the balloon crushes the atherosclerotic plaque and widens the artery, thus restoring blood flow to the distal coronary arteries and heart muscle.
TRANS-MYOCARDIAL LASER REVASCULARIZATION (TMLR)
Sometimes the coronary arteries are so badly diseased that it is not possible for surgery or angioplasty to restore blood flow. An innovative method of treatment for these cases is to construct new channels for blood to flow into the heart muscle using laser energy. At operation, laser beams are used to make tiny channels right through the wall of the left ventricle into it's cavity. Blood from inside the ventricle then passes through these channels and supplies the heart muscle with oxygen.
In brief, these are the major options to treat coronary artery blocks. In future articles, I will discuss each of these in greater detail.
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