Coronary Artery Bypass Graft (cont.)
How is coronary artery disease (CAD) treated?
Medicines used to treat angina reduce the heart muscle demand for oxygen in
order to compensate for the reduced blood supply. Three commonly used classes of
drugs are the nitrates, beta blockers and
calcium blockers.
Nitroglycerin
(Nitro-Bid) is an example of a nitrate. Examples of beta blockers include
propranolol (Inderal) and atenolol (Tenormin). Examples of calcium blockers
include nicardipine (Cardene) and
nifedipine (Procardia, Adalat). Unstable angina is
also treated with aspirin and the intravenous blood thinner heparin. Aspirin
prevents clumping of platelets, while
heparin prevents blood clotting on the
surface of plaques in a critically narrowed artery. When patients continue to
have angina despite maximum medications, or when significant ischemia still
occurs with exercise testing, coronary arteriography is usually indicated. Data
collected during coronary arteriography help doctors decide whether the patient
should be considered for percutaneous coronary intervention, or percutaneous
transluminal angioplasty (PTCA), whereby a small balloon is used to inflate the
blockage. Angioplasty (PTCA) is usually followed by placement of a stent or coronary artery
bypass graft surgery (CABG) to increase coronary artery blood flow.
Angioplasty can produce excellent results in carefully selected patients. Under
x-ray guidance, a wire is advanced from the groin to the coronary artery. A
small catheter with a balloon at the end is threaded over the wire to reach the
narrowed segment. The balloon is then inflated to push the artery open, and a
steel mesh stent is generally inserted.
CABG surgery is performed to relieve angina in patients who have failed
medical therapy and are not good candidates for angioplasty (PTCA). CABG surgery is ideal for
patients with multiple narrowings in multiple coronary artery branches, such as
is often seen in patients with diabetes. CABG surgery has been shown to improve
long-term survival in patients with significant narrowing of the left main
coronary artery, and in patients with significant narrowing of multiple
arteries, especially in those with decreased heart muscle pump function.
Next: How is CABG surgery done? »
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