Treatment for Coronary Artery Disease (CAD)

Most people only find out that they have coronary artery heart disease when they have an annual check-up. Usually they feel no symptoms or prior warning because the symptoms and signs of coronary artery heart disease are often only noted in the advanced stage of the disease or with a sudden failure of the heart muscle (heart attack). Please consider yourself as being lucky if you get early detection.

Heart failure is the end result of the accumulation of artheromatous plaque within the wall of the arteries that supply oxygen and nutrients to the myocardium (the muscle of the heart). The accumulation slowly increases with time until the artery is partially or completely blocked. In both cases, the doctor will administer medication as the first line of treatment. If the problem persists or gets worse, then balloon angioplasty will be recommended. If medication or balloon angioplasty is not possible, then the doctor will recommend bypass surgery.

Before an angioplasty, Echocardiography coronary angiography and left Ventriculography are usually used to examine the characteristics and the state of the coronary artery in detail. From the data obtained, the doctor will know the degree and the location of the blockage, the condition of the heart muscle, the contraction strength and any degree of failure of the heart muscle.

Balloon angioplasty is performed at the blockage area to allow the blood flow to the heart muscle again. The doctor will insert a long, narrow tube with a deflated balloon attached to one end into a small opening in the blood vessel until the deflated balloon is inside the blockage. The balloon is then inflated. It compresses the artheromatous plaque and stretches and expands the artery wall. The blood flow is renewed and the balloon is deflated and removed. Currently, it is generally practice that an expandable wire mesh tube (called a stent) was with the balloon. After the balloon is removed, the stent is implanted and left behind. The stent provides a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries. This can keep the heart patients healthy for long periods of time.

A surgical procedure performed to relieve angina and reduce the risk of death from coronary artery heart disease is called coronary artery bypass surgery. It uses the same principle as making a new road to avoid congested traffic. Arteries or veins from elsewhere in the patient’s body are grafted on to the coronary arteries to bypass the atherosclerotic blockages and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). Bypass surgery can be done at more than one location on the same vessel.

There is more than one method which can be used for coronary artery bypass surgery. Some of them are:

• Off-pump coronary artery bypass surgery: This surgery is done without the use of the cardiopulmonary (heart-lung) machine. The method uses equipment to stop the coronary artery while other sections of the heart are functioning normally. This reduces the amount of blood needed, the operation time, the time for the patient to be under anesthetics, and the recovery time in the hospital. This method is also good for the older age group and those who are at high risk or have many complications.
• All Arterial Conduits: This is surgery which uses only the arteries, not the veins. The doctor harvests the graft from the internal thoracic arteries to connect with the vessel in the front side of the heart. The method gives very good result and the patients stay healthy for a very long period of time. An artery is more durable and there is less chance of the reformation of the artheromatous plaques than when using a vein. Doctor will use the graft from veins in the legs only when he cannot find a graft from the arteries in other places.
• Small Incision surgery: This is also called Minimally Invasive Direct Coronary Bypass (MIDCAB) surgery. It is a technique performing bypass surgery through a 5-10 cm incision. The patient will have no long scar in the leg as the old method. There is less pain in the incision area and in the upper thoracic area. It creates less damage to the nerves and tissue. It does not use the graft from veins in the leg, so the patient has a shorter recovery time and can move around faster and better than the old method.

No matter how good and well-developed is the present treatment for heart disease; prevention is still the best way to reduce the loss of both your money and time. Do not forget to take good care of your health through proper exercise, eat a proper diet, stop risk behaviors such as smoking an d have a check-up at least once a year. Heart chambers, the condition of heart valves and walls, and how well they fill and empty.