How is coronary heart disease (CHD) treated?
Medication and lifestyle change are the main ways to treat CHD. If these do not work, then some people need more invasive treatments such as angioplasty (when a small balloon is used to stretch and open any blockages) or bypass surgery (a surgical operation; when a new artery is use to bypass the blockage).
Medication
Medication is used to:
- reduce or stop the symptoms
- lower the risk of a heart attack
- control blood pressure
- lower cholesterol
- thin the blood to stop clots forming
Most people need a combination of different medications. All medication can have side effects. Your healthcare team will work with you to find the right combination that balances potential side effects with the benefits of particular treatments.
Medication for symptoms
Common medications used to treat angina include:
| Type of medicine | How do they work? |
| Nitrates (GTN spray, tablets under the tongue) | Open up the arteries |
| Beta-blockers (eg Bispoprolol, Atenolol) |
Slow the heart and reduce the work the heart has to do |
| Calcium channel blockers (eg Diltiazem, Verapamil, Amlodipine, Felodipine) |
Reduce the work the heart has to do. Some also slow the heart |
| Potassium channel activators (eg Nicorandil) | Open up the arteries |
Medication to reduce the risk of heart attack
Medications that have been shown to reduce heart attacks include:
| Type of medicine | How do they work? |
| Anti-platelet (eg Aspirin, Clopidogrel) | Reduces risk of blood clots forming |
| Statins (eg Atorvastatin, Rosuvastatin) | Stop the build up of fatty material within the arteries |
| Angiotensin-converting enzyme (“ACE”) inhibitors (eg Ramipril, Lisinopril) |
Reduce the work the heart has to do Control blood pressure |
Non-drug treatments
Healthy Living
Making changes to your day to day activities can improve symptoms as well as reducing the risk of angina and heart attacks.
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Smoking any form of tobacco (cigarettes, cigars, pipes, shisha) as well as chewing tobacco causes narrowing of blood vessels. Stopping smoking, even if you have smoked for many years, will have immediate benefits on your heart and reduce the risk of angina or a heart attack. |
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There are some simple things you can do to make what you eat day to day healthier:
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Alcohol can damage heart muscle and contribute to narrowing of blood vessels by causing high blood pressure. Although there is a feeling that a small amount of alcohol is beneficial, the evidence for this is not clear. If you do choose to drink alcohol the guidelines are:
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All forms of physical activity and exercise help to keep your heart and you healthy. This doesn’t mean you have to go to the gym. It is more about choosing something that you enjoy which also makes your heart beat a bit faster and makes you breathe a bit harder. Carrying heavy shopping, housework and gardening all count as physical activity. CHD should not be a barrier to doing physical activity although you may need to choose an activity that will not put too much strain on your heart. Your doctor will be able to advise on any activities you should avoid. It is important to speak to your healthcare team if you are thinking of taking up exercise that is new to you or more strenuous than you are used to. If you get symptoms of angina or undue breathlessness when exercising
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Learning how to cope with stress is important but can be difficult. It is useful to consciously develop means of dealing with or avoiding situations that are going to cause stress. In addition, unwinding with hobbies such as yoga and meditation or simply chatting with friends and family can all help. |
Specialised Treatments
Angioplasty and Stenting
Coronary angioplasty is when a balloon is used to open up a narrowed artery. A thin flexible tube is put into a blood vessel in the groin and threaded up to the coronary artery. Angioplasties are done under local anaesthetic, meaning that people are awake but have a medicine injected into the skin to make it numb.
Once the thin flexible tube is in the right place, a balloon is inflated inside the artery, squashing the fatty material and widening the narrowing. Very often a short wire mesh tube called a stent is then left in to keep the artery open.
Bypass surgery
Bypass surgery, also known as coronary artery bypass grafting (CABG), is an operation to divert blood around a narrowing or blockage in a coronary artery. The operation is done under general anaesthetic, so people having this are completely asleep.
The surgeon will take a blood vessel from another part of the body and attach it above and below the narrowing or blockage. The blood vessel used is called the graft. If there are several narrowings or blockages, the surgeon will use more than one graft during the operation.
