Diagnosis


Treatment


Medication


Diagnosis

Electrocardiogram (ECG)

An electrocardiogram records the electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that’s in progress.In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.


Echocardiogram

An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.

Stress test

This particular test measures the stress on your heart during physical activity and while at rest. The test monitors your heart’s electrical activity while you walk on a treadmill or ride a stationary bike. Nuclear imaging may also be performed for a portion of this test. For those unable to perform physical exercise, certain medications can be used instead for stress testing. 


Heart scan

Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

Cardiac catheterization (left heart catheterization)

During this procedure, your doctor injects a special dye into your coronary arteries through a catheter inserted through an artery in your groin or forearm. The dye helps enhance the radiographic image of your coronary arteries to identify any blockages.


CT coronary angiogram

In which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.

Treatment

Lifestyle changes:

Quit Smoking

Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.

Exercise regularly

Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor’s OK, aim for about 150 minutes a week of moderate physical activity. For example, try walking for about 30 minutes on most or all days of the week.

A heart-healthy diet

Lessen processed food and more on a low-trans-fat, low-salt and low-sugar diet- A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts — and is low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial.

Avoid saturated fat and trans fat, excess salt, and excess sugar

If you drink alcohol, drink it in moderation — this means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

If you have diabetes, monitor your blood sugar

If you have diabetes, tight blood sugar management can help reduce the risk of heart disease.

Reduce stress

Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

Medication

Bypass Surgeries:

Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.

Angiotensin II receptor

Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising.

Anticoagulants

Decreases the clotting (coagulating) ability of the blood. Sometimes called blood thinners, although they do not actually thin the blood. They do NOT dissolve existing blood clots. Used to treat certain blood vessel, heart and lung conditions.

Antiplatelet drugs

Keeps blood clots from forming by preventing blood platelets from sticking together.

Beta-blockers

Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more slowly and with less force.

Calcium channel blockers

Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart’s pumping strength and relax blood vessels.

Statins

Statins work by blocking the formation of cholesterol and increasing the number of low density lipoprotein (LDL) receptors in the liver. This helps remove LDL cholesterol from your blood, which makes a heart attack less likely.

NOTE: Not all statins are suitable for everyone, so you may need to try several different types until you find one that is suitable.

Clot-dissolving drugs

While antiplatelet agents and anticoagulants prevent the formation of blood clots, they cannot dissolve existing blood clots and hence cannot be relied upon to open blocked arteries rapidly. 

Diuretics

Causes the body to rid itself of excess fluids and sodium through urination. Helps to relieve the heart’s workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. 

Morphine

Most people who have had a heart attack are experiencing severe discomfort and anxiety. Morphine has a calming effect and reduces the workload of the heart. 

Nitrates

Most people are given nitroglycerin, which relieves pain by reducing the workload of the heart and possibly by dilating arteries. Usually, it is first given under the tongue, then intravenously.

Ranolazine

Ranolazine is a drug used to treat angina in people who continue to have symptoms despite taking all other antianginal therapy. It may be more effective in women than in men.

Surgeries and Other Procedures

Bypass Surgeries:

Bypass Surgery

Coronary artery bypass grafting, or “CABG” (pronounced “cabbage”), is a common heart procedure. A surgeon takes a section of a healthy blood vessel from your leg, chest, or arm. The vessel is then connected (grafted) to your coronary artery slightly past the site of the blockage. This creates a new path for blood to flow around (bypass) the blockage in the artery so it can get to your heart. Patients undergoing bypass are put under general anesthetic and are not awake during surgery. Two bypass surgical procedures for coronary artery disease are: (1) beating heart surgery and (2) arrested heart surgery.


Beating Heart Surgery

Also known as off-pump surgery, beating heart surgery is done while the heart is beating. This often requires special equipment that allows the surgeon to operate on the heart while it is moving. Beating heart surgery is appropriate for certain patients.

Arrested Heart Surgery

Most CABG surgeries are done through an incision in the chest while the heart is stopped and a heart-lung machine takes over the job of circulating the blood. This is called arrested heart surgery or conventional bypass surgery.

Minimally Invasive Treatments:

Coronary Balloon Angioplasty

Coronary balloon angioplasty, also referred to as percutaneous (through the skin) coronary intervention (PCI), uses a tiny balloon to widen the inside channel of the artery and enable blood to flow at a normal or near-normal rate.

Stenting

Stenting uses a device called a stent to restore blood flow in the coronary artery. A stent is a tiny, expandable, mesh-like tube made of a metal such as stainless steel or cobalt alloy. Like in an angioplasty procedure, a stent mounted onto a tiny balloon is opened inside of an artery to push back plaque and to restore blood flow.


MICS CABG

The beating heart procedure described above can be performed through a small rib incision rather than through a median sternotomy.

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