Coronary heart disease - treatment

Depending on the stage of the disease, the following measures can be considered, which can be used individually or in combination:

  • Control of risk factors
  • drugs
  • Elongation of coronary vasoconstriction through special cardiac catheter
  • Heart bypass surgery

Control of risk factors

The basis of every treatment for coronary heart disease is the consistent control of the risk factors in order to prevent progression of the disease as far as possible and, in the best case, to achieve a regression of calcification in the heart. This means specifically:

  • Weight regulation in overweight
  • Alcohol and nicotine abstinence
  • Diet measures in diabetes
  • medical treatment of lipid metabolism disorder or gout
  • Reduction of mental stress factors
  • adequate physical activity

If the measures described and, if necessary, the treatment of the other diseases are not sufficient, cardiac medications will be prescribed. Even after a heart attack, treatment with pills follows to adjust blood pressure, improve blood flow, and make work easier for the weakened heart muscle.

Surgery for coronary heart disease

Direct intervention on the coronary vessels in chronic circulatory disorders or in acute myocardial infarction are possible in the context of a cardiac catheterization. By means of special inflatable balloons at the top of cardiac catheters, which are introduced into the coronary vessels themselves, individual bottlenecks can be expanded and the blood flow can be normalized.

Unfortunately, in about 20 to 30 percent of the cases that have been successfully treated, there are new bottlenecks (restenosis) in the same area, which can be inflated again by balloon catheters. To reduce the risk of reperfusion, stents are often used - stretchable, mesh-like tubes made of stainless steel, which keep the vessel open. Some of them also slowly give off medication.

In severe calcification of all major coronary vessels in some cases, only a bypass surgery is considered. In this large heart operation, veins taken from other parts of the body (usually the lower legs) of the patient are sutured as vascular bridges over the narrowed coronary vessels. Due to the increasing risk of surgery re-bypass operations are performed in case of inoperability of the primary bypasses only in a few isolated cases.

Treatment of complications

Corresponding to the complex appearance of coronary heart disease, chronic sequelae of circulatory disorders of the heart muscle or of expired heart attacks must also be specially treated. As a result of acute or chronic circulatory disorders, a variety of arrhythmias can occur in patients with coronary heart disease, which can be associated with both too slow and too fast a heart rhythm.

  • Chronic, recurring arrhythmias from the ventricles of the heart, the formation of which is promoted by infarct scars, are a particular problem. Since, according to current knowledge, one hundred percent safe drug therapy for these cardiac arrhythmias is unfortunately not possible, implantable automatic defibrillators the size of a cigarette case have been developed since the mid-80s, which are used under the breast muscle left above the heart. Although these do not prevent arrhythmias, they can be effectively treated by the emergency delivery of an electric shock.
  • Heart failure after one or more heart attacks is usually treated with medication, in severe cases also with heart transplantation.
  • Circulatory dysfunction of the heart valves require a drug treatment or the surgical replacement of the damaged heart valve by artificial valve prostheses.
  • If there are acute or chronic circulatory disorders of the heart muscle, coagulation disorders or blood clots that have been carried off into the coronary arteries, blood-thinning medication must be used for life.

Preventive measures

The best cure of a disease is known to be its prevention. Especially in the case of coronary heart disease, there are a whole range of possibilities for significantly reducing the probability of a disease by controlling individual risk factors, as described above.

Above all, it is important to raise awareness that our modern, poor lifestyle and Western eating habits greatly enhance vascular disease in general and coronary heart disease in particular. If risk factors such as genetic stress exist, particular attention should be paid to additional avoidable or treatable risks.

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