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Content
Heart Disease
Heart Attack
Congestive Heart Failure
Generic Drugs
Alternative Heart Disease Treatment |
Heart Disease
Heart Disease Treatment Heart Disease
Treatment
From Emedicine.com
Self-Care at Home
If you think you are having a heart attack, seek help immediately. Do not
ignore chest pain or discomfort. Time is of vital importance. Call 911 for
emergency transport to the hospital. Do not try to drive yourself or being
driven by someone else.
If you have regular-strength or baby aspirin available and you are not
strongly allergic, chew and swallow 1 regular aspirin or 2 baby aspirins.
- At this dose, aspirin may help maintain blood flow through a
clot-filled artery by inhibiting blood clotting.
- Chewing gets the aspirin into your system faster than swallowing it
whole.
If you have had angina and been given nitroglycerin, take as recommended
by your health care provider. Exact instructions will depend on the form of
the nitroglycerin.
If you have had a heart attack before, or if you have several risk
factors, the following steps may help prevent heart attacks and save you
from severe disability or even death.
- Take a low-dose aspirin tablet (160 or 325 mg) every day. Aspirin
increases the risk of bleeding in some people. Ask your health care
provider before taking daily aspirin.
- If you smoke, quit. This is the single best lifestyle change you can
make. After 3 years of not smoking, the risk of heart disease drops to the
level of a nonsmoker. Your health care provider can help you quit smoking
through behavioral changes, medications, or use of nicotine replacement
products.
- Lower the cholesterol level in your blood. Lowering your cholesterol,
especially the level of "bad" LDL cholesterol, keeps plaques from building
up in the coronary arteries. The total cholesterol level should be kept
below 200 mg/dL, and the LDL cholesterol level below 130 mg/dL (under 100
mg/dL in those with known heart disease or diabetes). Some people are able
to control their cholesterol level by changing what they eat; others
require medication.
- Keep your intake of calories from fat under 30% of your total
calories. This translates to an intake of less than 60 grams of fat per
day for an adult. Most diets in Western countries contain more fat than is
recommended.
- Control blood pressure. Uncontrolled high blood pressure is one of the
most common causes of heart disease.
- Control diabetes carefully. Uncontrolled diabetes increases your risk
of heart disease, heart attacks, and circulation problems.
- If you take hormone replacement therapy (HRT), talk with your health
care provider right away. HRT is no longer considered to protect women
from heart disease and heart attacks.
Medical Treatment
Medical treatment may be started immediately, before a definite diagnosis
of a heart problem is made.
General treatment measures include the following:
- Oxygen through a tube in the nose or face mask
- Nitroglycerin under the tongue
- Pain medicines (morphine or meperidine)
- Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).
Clot-dissolving medicines: The tissue plasminogen activators (tPAs) can
actually dissolve clots in some circumstances.
- The earlier these drugs are given, the better the chance of opening
the blocked artery and of protecting the cardiac muscle from further
injury.
- If more than 6 hours has passed since the onset of chest pain, these
drugs are less helpful.
- Potential risks of this therapy include bleeding.
- The most serious risk is a stroke (bleeding into the brain).
Angioplasty: Emergency coronary angiography and coronary balloon
angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) are
available in hospitals equipped with a full-service cardiac catheterization
laboratory. This is the most direct method of relieving blockage in a
coronary artery.
- Coronary balloon angioplasty is an extension of coronary angiography.
- A long, thin tube (catheter) is inserted in an artery in the groin or
arm.
- At the tip of the catheter is a tiny, elongated balloon, which is
threaded over a hair-thin guidewire into the narrowed coronary artery.
- Once the balloon is positioned at the blockage in the coronary artery,
it is inflated.
- The balloon pushes aside the plaque and clot that are blocking the
artery, allowing blood to flow more freely.
- The balloon is then deflated and removed with the catheter.
Stenting: A stent is a small, springlike device that may be inserted into
a coronary artery after balloon angioplasty. After the catheter and balloon
are removed, the stent stays in place, holding the artery open. A stent is
better than angioplasty alone at keeping the artery from narrowing again.
Atherectomy: Sometimes the plaques are too rigid, bulky, or calcified to
be treated by balloon angioplasty. In these cases, the plaque often can be
removed by cutting it out with a drill-like rotary blade or a laser or other
tool.
Medications
If you are having a heart attack, you will almost certainly be given some
or all of these medications while you are in the hospital. Some you will
continue taking at home.
- Intravenous (IV) nitroglycerin has been shown to improve blood flow to
the heart muscle by relaxing (dilating) the coronary arteries and
increasing blood flow. It is usually given for 24-48 hours continuously.
- Heparin is a "blood thinner," or anticoagulant, which may be given
after a heart attack. Heparin does not remove an existing clot, but it
reduces the tendency of blood to clot in the coronary arteries. Some newer
forms of heparin have recently been introduced that can be given as a shot
instead of through an IV line.
- Beta-blockers are medications that decrease the heart rate and blood
pressure. This reduces the heart's workload and thus the amount of oxygen
it needs. Beta-blockers may provide immediate as well as long-term benefit
for people who have a heart attack.
- Angiotensin-converting enzyme (ACE) inhibitors may prevent repeat
heart attacks and other problems when started early during a heart attack.
They are especially useful in people with diabetes and those with a
weakened heart muscle congestive heart failure).
Surgery
Sometimes cardiac catheterization reveals extensive coronary artery
disease. In such cases, you will need to undergo coronary bypass surgery.
- Standard coronary artery bypass grafting (CABG) is performed if many
coronary arteries are narrowed or blocked. This is especially recommended
when the left main coronary artery shows significant blockage. This is
"open heart surgery," meaning that the chest wall is opened. When
performing a bypass, heart surgeons use sections of the mammary artery
from the chest or veins from the legs to create detours around the blocked
arteries. For this surgery, you will be connected to a bypass pump, which
does the work of the heart during the operation. Although this sounds
dangerous, this surgery is considered very safe and has a very low rate of
complications.
- Off-pump bypass surgery: Sometimes the surgeon can perform open heart
surgery without using a bypass pump. The heart continues to beat during
surgery. This type of surgery has even fewer complications than the
standard procedure but is not always feasible.
- Minimally invasive coronary bypass: If just the front or the right
coronary artery needs bypass, the bypass may be performed via a small
keyhole-type incision without a large incision in the chest. The internal
mammary artery is used for the bypass.
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