Currently, there are no methods to turn back the development of coronary artery disease, and full recovery from it is impossible. However, in a timely and effective early treatment measures can slow down the progression of the disease, significantly increase the length and quality of life of the patient.
The key to successful treatment of coronary artery disease is the elimination of all risk factors:
- lifestyle change
- lowering blood pressure,
- healthy eating and sleeping,
- normalization of blood sugar, cholesterol,
- smoking cessation,
- physical activity etc.
More than half of the success can be achieved without resorting to drugs. But the greatest effect must take medication, supporting normal pressure, cholesterol, and blood viscosity. Take the medication must be constantly, throughout their lives. On this depends the success of the treatment.
With a sharp deterioration in health (decompensation) Might need to be treated in the hospital and receive additional medication. This is especially true in patients with advanced stage disease and heart failure. With a properly sized treat these cases can be reduced to a minimum. The smaller the patient calls for an ambulance, and there is less need for hospital treatment, the better the quality control of the disease.
Surgical method used in the case of atherosclerosis of the coronary arteries, because no one drug may not reduce cholesterol plaque size or expand the artery, except for surgical intervention. In heavy cases of congestive heart failure is the only effective means of a heart transplant.
Indications for hospitalization
- First appeared chest pain (angina)
- First arising or severe arrhythmia
- Worsening angina
- Decompensated heart failure (sudden deterioration of health, accompanied by an increase in edema, dyspnea, ECG changes)
- Suspected myocardial infarction and other acute conditions
- Preparing for surgery
In other cases, coronary artery disease can be successfully treated at home.
What medications are used to treat coronary artery disease
Drugs that lower blood pressure
High blood pressure has a negative impact on the blood vessels of the heart and other organs, causing them to shrink even more and get less oxygen. Reducing and constant maintenance of normal blood pressure — a key factor in the treatment of coronary artery disease. The target blood pressure levels in ischemic heart disease is 140/90 mm Hg or less for the majority of patients, or 130/90 for patients with diabetes or renal disease. For critically ill patients are recommended even lower figures. In most cases, to achieve this level of blood pressure requires constant antihypertensive drugs.
This class of drugs that block angiotensin enzyme 2, which causes an increase in pressure and other negative effects on the heart, kidney and vessels. Recently proven many positive effects of ACE inhibitors on the prognosis of patients with coronary artery disease, so they are appointed as widely as possible, in the absence of contraindications. These include, for example, enalapril, lisinopril, perindopril, and others. With prolonged use can cause coughing, are not suitable for all patients. Applied by a doctor.
Angiotensin receptor blockers
These tools not the block angiotensin 2 and its receptors, which are in various organs, including the heart. In some cases, it is much more efficient. ARBs lower blood pressure as effectively as ACE inhibitors, but they have a few additional beneficial effects on the heart and blood vessels. In particular, some of them can stop the proliferation of cardiac muscle (hypertrophy), and even to reduce it several percent. They are used in all groups of patients, especially those who can not tolerate ACE inhibitors.
The use of long-term, life, prescribed by a doctor. Formulation Examples: losartan ("Cozaar" "Losap" "Lorista"), valsartan ("Valz" "Diovan" "Valsakor"), candesartan ("Atakand"), telmisartan ("Micardis") and others.
Selection of a particular drug, its scheme of administration and dose is the responsibility of the doctor, as this is necessary to take into account the individual characteristics of the disease and related conditions.
Drugs that improve the functioning of the heart
Block receptors of adrenaline and other stress hormones in the heart. Reduce heart rate and blood pressure. Beneficial effect on the heart during arrhythmias and may eliminate it.
Recommended for the permanent application of all patients after myocardial infarction and PIS, and with left ventricular dysfunction, regardless of heart failure in the absence of contraindications. Application can be long or short, only when prescribed by a physician. Most of them are contraindicated in bronchial asthma, many raise blood sugar and do not apply in diabetes.
Formulation Examples: propranolol, metoprolol ("Egilok"), bisoprolol ("Konkor"), etc.
Essential drugs for the relief of (address) attack. These include tools such as nitroglycerin ("Nitromintum"), isosorbide dinitrate ("Isoketum") and mononitrate ("Monocinque"), etc. They act directly on the coronary vessels and lead to their rapid expansion and reduce the blood flow to the heart through the expansion of deep vein thrombosis, which can store up blood. All this facilitates the work of the heart and reduces oxygen demand, and hence reduces the pain and anoxia.
Currently, nitrates are used primarily for the relief of angina attacks, and for continuous use — in patients with severe chronic heart failure. All nitrates develops addictive, and their effect decreases with time, but after a brief withdrawal, he again restored.
Digoxin, korglikon etc. Strengthen heart muscle and slow down their frequency. Are currently used in the treatment of coronary artery disease infrequently, mainly for atrial fibrillation and edema. Have a lot of side effects, especially in combination with diuretics and therefore should be given only after a thorough medical examination.
Drugs that lower cholesterol
For most patients, we recommend the following figures:
- total cholesterol should be less than 5 mmol / l,
- Cholesterol LDL ("bad") — not more than 3 mmol / l
- Cholesterol HDL ("good") is not less than 1.0 mmol / l.
He also plays the role of atherogenic index and triglyceride levels. In severe cases (eg with concomitant diabetes), these indicators are recommended to control more strictly.
Target cholesterol levels achieved using special diets and drugs. In most cases a sufficient diet, but without medication will not be as effective. Modern drugs can significantly lower cholesterol, but they must be taken continuously. Mostly used for this drug of statins (atorvastatin, simvastatin, etc.). Specific drug prescribed by a doctor.
Drugs that reduce blood viscosity
The more viscous the blood, the greater the likelihood of blood clots in the coronary arteries and blood flow to the heart muscle is worse. To reduce the viscosity of the blood of the two groups of drugs are used: antiplatelet agents and anticoagulants.
The most common antiplatelet — aspirin. It is recommended to be taken daily to all patients with CHD life in a dose of 70 — 150 mg per day (in the absence of contraindications, such as a stomach ulcer). Patients after cardiac surgery and vascular dose may be increased by a physician, as well as added to clopidogrel 75 mg per day.
In patients with persistent atrial fibrillation doctor may prescribe stronger medications reception — the anticoagulant warfarin, at a dosage sufficient to maintain an INR value (a measure of blood clotting) of 2.0 — 3.0. Warfarin dissolves blood clots more potent than aspirin, but it can cause bleeding. It is used only by a physician after a thorough examination and under the control of blood tests.
Drugs that control blood sugar (glucose), blood
Modern criteria for control of diabetes — the level of glycated hemoglobin (HbA1c). It reflects the concentration of blood sugar in the last week and should not exceed 7%. A one-time blood sugar does not reflect the true picture of diabetes.
To achieve the target glucose levels should be used all the non-drug measures (diet, fiznagruzki, weight loss), and in case of failure — the specific medication prescribed by a doctor endocrinologist.
Diuretics (water pills)
Has two applications: a low dose to reduce the blood pressure (often in combination with other drugs), high doses — for removing fluid from the body in congestive heart failure. They have the property to increase blood sugar, diabetes therefore used in extreme cases.
Antigipoksanty — are drugs that reduce myocardial anoxia at the molecular level. One such drug is trimetazidine. It is not included in the standard regimen CHD can be used as additional means. Not registered in the U.S. Pharmacopeia.
Nonsteroidal antiinflammatory drugs (NSAIDs)
Shirokomasshabnoe U.S. study has revealed the harmful effects of this class of drugs on the prognosis of patients with myocardial infarction. In this regard, drugs such as diclofenac, ibuprofen, are not recommended for use in humans after infarction and its equivalent conditions.
Vaccination against influenza
Recommended for all people with diseases of the cardiovascular system.
Treatment coronary heart disease lasts a lifetime and should be carefully planned. In the period of observation is necessary to strictly adhere to the treatment regimen developed, and in the case of side effects or deterioration immediately contact a doctor.
Many medicinal nReparata must be taken for life. These include aspirin (or analogs) against the pressure of drugs, drugs for normalizing blood glucose and cholesterol, and in some cases, other drugs. The sudden cancellation of lekarstva by choice or even a dose reduction may lead to a sharp deterioration of health and decompensation, and this increases the likelihood of deadly complications (heart attack, heart failure, etc.).
Changes in the way of life and the regime, must be strong and unwavering. Often, small flaws in the diet, such as extra eaten herring, may lead to a spike in pressure and deterioration of the disease.
Usually the doctor appoints the date of the next visit. If he did not ask him about it. A careful medical supervision and regular checks — a necessary and important part of treatment. If you are unsure or in doubt about the adequacy of their doctor appointments, or would like further advice, please contact a specialized consultative or diagnostic cardiology center.
In the former Soviet Union was spread phenomenon of admission to hospital for prevention. In the case of treatment of coronary artery disease, this strategy is not optimal either in terms of the quality control of the disease, either in terms of patient adherence to treatment, and should be avoided.
Treatment with interruptions from time to time, does not provide for the necessary control over the CHD risk factors and disease course. Patients have become more likely to believe that their "podlechat", after which they again will be engaged in a former life, and everything will be as before. This is a big misconception that results in failure of the constant medication, large fluctuations in blood pressure and, lack of control over the disease.
For one or two weeks in the hospital every half year, it is impossible to achieve a real change in the course of the disease, except for a symptomatic improvement. Many patients perceive this improvement as a small victory over the disease, and continue to live the same life. However, this is not the case: coronary heart disease without changing lifestyles and supportive medication continues to progress, resulting in a sudden death or heart attack. Reduce your risk and prolong life can only be sustained rather than intermittent treatment modality.