CAD generally is treated by relieving the localized blockages caused by plaques. Usually this is done by angioplasty and stenting. With angioplasty, a balloon attached to a catheter is blown up at the site of a plaque, to compress the plaque and relive the obstruction. A stent- a tiny metal scaffold - is then inserted to keep the plaque from growing again. If angioplasty and stenting are not feasible, coronary artery bypass surgery may be performed. Medical therapy can also control the symptoms of angina (nitrates, calcium blockers, beta blockers,) and help prevent the clotting that can lead to MI (aspirin.)
Acute MIs are medical emergencies. Once the diagnosis is made (by ECG changes and blood enzyme tests,) attempts to re-open the blocked artery should begin immediately, either with clot-dissolving drugs or with angioplasty. In a hospital set up for rapid emergency catheterization, angioplasty may be the best therapy. Otherwise, the clot-busting drugs are probably a better option. (See "How to survive a heart attack - the 1st 24 hours.")
Once the patient's acute MI is stabilized, a number of steps are necessary to optimize the long-term outcome. These include several drugs (beta blockers, ACE inhibitors, aspirin, and statins) that have been shown to improve long-term survival after a heart attack. Further, patients with significant heart muscle damage have a high risk of subsequent sudden death, and should receive implantable defibrillators (pacemaker-like devices that automatically treat lethal heart rhythm disturbances.) (See "How to survive a heart attack - after the first day.")
Unfortunately, doctors have not been particularly efficient in instituting these proven treatments; fewer than half the survivors of MI are placed on adequate long-term therapy, and the scorecard is worse for women than for men. The result is preventable death and suffering. Here is one area, in particular, where a knowledgeable patient has a huge advantage in assuring they receive adequate medical care. ( See "Post Heart Attack Check-List.")
Finally, we must recognize that CAD is not a static condition, but is a progressive disease that - unless drastic changes are made -continually worsens over time. Stents and bypass surgery do not cure anything, but merely serve to buy some time. Thus, once CAD is present it is vitally important to control allthe risk factors that produced the CAD in the first place, to slow or halt the progress of this disease.
