When fatty deposits narrow the arteries in your heart, the consequences can be deadly. Reduced blood flow starves the heart of oxygen, causing an often severe form of chest pain called angina. You tire easily and may be unable to exercise. And your risk of heart attack is dramatically increased.
A technique known as coronary artery bypass graft (CABG) surgery has proven very effective at creating a detour around these potentially deadly blockages. But any form of surgery especially open-heart procedures like CABG is risky. In fact, 1% to 2% of individuals who undergo bypass surgery die in the hospital.
The risk is especially great for diabetics and hypertensive and those who have already sustained a heart attack or have had previous bypass surgery
Good news: Blocked coronary arteries can often be opened up via drug therapy or less invasive surgical procedures even lifestyle changes.
Evaluating the blockage
If you develop chest pain or excessive shortness of breath upon exertion, or if you have other symptoms of coronary artery disease, your doctor will probably schedule some noninvasive diagnostic tests
- Stress electrocardiogram (cardiac stress test) monitors the heart’s electrical activity during strenuous exercise.
- Thallium scans and positron emission tomography (PET) check to see if certain areas of the heart are deprived of oxygen-rich blood. If tests suggest significant blockage, your doctor will probably recommend angiography.
In this low-risk procedure, a narrow tube (catheter) is inserted through an incision in the groin and threaded up to the coronary arteries. Special dye injected through the catheter renders coronary arteries visible on X-ray equipment.
Drug therapy
If the blockage is severe, your doctor may recommend immediate surgery. In most cases, however, the first treatment is medication
• Nitroglycerin (Monoket, Imdur)
Tiny pills containing this time-tested drug can be placed under the tongue at the first sign of angina or supplied all day long via a skin patch or pills. It relaxes veins, diminishing the amount of blood returned to the heart. This allows the heart to work less. It also relaxes coronary arteries.
• Beta-blockers (Lopressor, Tenormin, Inderal)
These oral drugs limit the heart’s response to adrenaline in the bloodstream. Since the heart pumps more slowly, it needs less oxygen.
• Calcium channel blockers (Calan, Pro¬ cardia, Cardizem).
This family of oral medications relaxes arteries and lowers blood pressure. Some of these medications should not be used by those with heart failure. Short-acting nifedipine (Procardia) probably shouldn’t be used at all with coronary disease.
Three other groups of medications may also be helpful
- Aspirin may reduce the risk of heart attack by preventing platelets from sticking together and forming clots.
- ACE inhibitors (Capoten, Vasotec, Prinivil) are especially valuable in treating or preventing heart failure after a heart attack.
- Cholesterol-lowering drugs (Mevacor, Zocor, Pravachol, Questran and niacin) work primarily by lowering “bad” LDL cholesterol and, in some cases, raising “good” HDL cholesterol.
If your angina worsens despite drug therapy, your doctor will probably recommend bypass surgery or angioplasty.
Angioplasty
In this procedure, a catheter is used to introduce a tiny balloon into the coronary arteries. The balloon expands to squash the fatty deposits blocking the arteries.
If blockages aren’t too numerous or severe enough to necessitate bypass, and drugs really aren’t doing the trick, then angioplasty may be appropriate.
Angioplasty involves less pain and risk than bypass surgery. You may be out of the hospital in a few hours at most a couple of days and back to full activity shortly thereafter.
Drawback: In up to 50% of cases, the artery closes again often within six months and the procedure must be repeated.
In recent years, a variation on angioplasty has become popular. After the blocked artery is opened, a mesh reinforcing tube called a stent is inserted. With a stent, the chance of the artery closing again is cut by 50%.
Coronary bypass
In bypass surgery, the chest is opened, the ribs are spread and the heart is cooled to a standstill while a heart-lung machine takes over. Blood vessels “harvested” from the leg or chest are grafted onto the coronary arteries in such a way that they carry blood around the blockage.
Bypass surgery is the only reasonable option if tests reveal obstruction of the left main coronary artery. Bypass is also the best bet if three or more coronary arteries are blocked and function of the left ventricle is diminished.
Bypass surgery requires at least four days of hospitalization, and several weeks of recuperation at home. It may take two to four months before you can resume a full, active life. The grafts generally stay open for five to 15 years but may close earlier.
Lifestyle modification
We all know that a low-fat diet, exercise and stress reduction can help prevent heart dis¬ ease. These strategies can also relieve angina even reverse coronary artery disease.
You may have heard of the program developed by Dr. Dean Ornish, of the Preventive Medicine Research Institute in Sausalito, CA. His program is not a substitute for bypass or angioplasty if you have life-threatening artery blockage or if you have unstable angina that does not respond to medication.
But for patients in the “gray zone” where neither Coronary Artery Bypass Graft (CABG) nor angioplasty offers any clear advantages, lifestyle intervention may be the best option. The program involves
• A very low-fat vegetarian diet
To reduce total fat to 10% of calories, participants learn to cook without oil or other forms of fat. The American Heart Association recommends that 30% of calories come from fat but that’s too high.
• Aerobic exercise
Jogging, Brisk walking, stair-climbing or biking, at least three hours a week are best aerobic exercise.
• Yoga, stretching and meditation
Yoga, stretching and meditation for an hour a day facilitates deep relaxation.
• Group therapy
To teach people ways to express their emotions and improve their relationships.
For the first three months, program participants come in three times a week for exercise, diet counseling, stress reduction and group therapy. For the next nine months, they come once a week.
By then, they have incorporated the diet, exercise and stress-reduction into their lives.
