Coronary heart disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Goals of Treatment
- Goals for treating people who have coronary artery disease:
- Blood pressure less than or equal to 140/90 (even lower for some patients with diabetes, kidney disease, and heart failure)
- Glycosylated hemoglobin (HbA1c) levels less than or equal to 7%
- LDL cholesterol level less than or equal to 100 mg/dL (even lower for some patients)
Medical Therapy
- Treatment depends on symptoms and how severe the disease is. Medications to treat CHD, include:
- ACE inhibitors to lower blood pressure and protect the heart and kidneys.
- Aspirin, with or without clopidogrel (Plavix) or prasugrel (Effient) to help prevent blood clots from forming in the arteries and reduce risk of having a heart attack.
- Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart. These reduce the risk of arrhythmias and improve survival after a heart attack or with heart failure.
- Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart.
- Diuretics to lower blood pressure and treat congestive heart failure.
- Nitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart.
- Statins to lower cholesterol.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [1]
Recommendations for Ventricular Arrhythmias with High Lipids
| Class I |
| "1. Statin therapy is beneficial in patients with CHD to reduce the risk of vascular events, possibly ventricular arrhythmias, and SCD. (Level of Evidence: A). " |
| Class IIb |
| "1. n-3 polyunsaturated fatty acid supplementation may be considered for patients with ventricular arrhythmias and underlying CHD. (Level of Evidence: B)" |
Medical Therapy for Angina
Angina that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade narrowings of the heart arteries. The symptoms of angina are often treated with nitrate preparations such as nitroglycerin, which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.
Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done.
References
- ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.