Options for Treating Heart Disease

While the blood-pumping technique known as Enhanced External Counterpulsation, or EECP, has some proponents in the United States, drug therapy is still the first-line treatment for coronary artery disease and angina. Your doctor may treat angina symptoms with medications such as nitroglycerine. The doctor will assess you for other risk factors such as high cholesterol, high blood pressure and diabetes, and prescribe, for example, cholesterol-lowering drugs called statins. To prevent a heart attack and slow the progression of coronary artery disease, a doctor will also often prescribe drugs to ease the heart's workload. These include:

1. beta blockers, which lower the heart rate, blood pressure and the heart's need for oxygen;

2. angiotensin-converting enzyme (ACE) inhibitors, which block an enzyme involved in constricting blood vessels, thereby lowering blood pressure;

3. calcium channel blockers, which inhibit the movement of calcium into cells of the heart and blood vessels, reducing the heart's oxygen consumption and relaxing blood vessels.

Your doctor may also recommend anti-platelet therapy such as aspirin.

When drugs prove ineffective on their own, the next step is generally surgery. But surgical procedures used to treat symptoms associated with blocked arteries, such as chest pain (angina) or heart attack, aren't uniformly effective and have their own drawbacks. Treatment options include:

· Coronary artery bypass grafting (CABG)

Pronounced "cabbage," it is the most common open heart operation in the United States: Cardiothoracic surgeons performed 515,000 of these bypasses in 2001 to avoid blockages of the coronary arteries, according to the American Heart Association. The technique involves an incision down the front of the chest through the breastbone. Bypasses use a vein or an artery from elsewhere in the body to carry blood around the obstruction. The vein or artery is attached at one end to the aorta -- the main artery coming out of the heart -- and at the other end to the coronary artery beyond the blockage.

A bypass may relieve symptoms and boost exercise capacity. And long-term survival rates for CABG patients with two or more diseased arteries appear higher than for similar patients who've received stents, according to a study in last week's New England Journal of Medicine. But changes in both methods since the study was conducted make the finding less valuable.

For up to roughly a quarter of patients, angina pain may return within a year. Other risks include infection (open chest wounds are notoriously hard to heal), bleeding and stenosis (a narrowing) of graft tissue after a few months or years.

· Angioplasty

This term describes any of several procedures used to open blockages in coronary arteries that are impeding blood flow to the heart. Other common names are percutaneous coronary intervention (PCI), balloon angioplasty or percutaneous transluminal coronary angioplasty (PTCA). According to the American Heart Association, 1.2 million angioplasties were done in the United States in 2002.