Treatments—Conventional Cardiology
by Rashmi Gulati, MD
At any stage of heart failure, the patient's treatment regime will include lifestyle measures, medication, and ongoing care. Conventional treatments for severe heart failure may also include medical procedures and surgery. First and foremost, however, healthy eating habits must be incorporated into daily life. Then the underlying causes, which could include high blood pressure, diabetes, or coronary artery disease, must be addressed.
Heart Disease Medications
There are many different types of medications for heart disease, including beta blockers, calcium channel blockers, diuretics, ACE inhibitors, statins, AT2 receptor antagonists, digoxin, and isosorbide dinitrate/hydralazine hydrochloride. Many if not most of these types of medications have major side effects, such as impotence, blood sugar problems, blood fatty substance abnormalities, swollen legs, constipation, and more.
Balloon Angioplasty
In balloon angioplasty the surgeon/physician inserts a catheter into a vein in the groin or elbow, threading it up to the blocked coronary artery. Through this catheter another catheter of smaller diameter is fed, at the tip of which is a small balloon encased by a thin, mesh metal tube called a stent. The stent is advanced to the blockage and put in place by inflating the balloon. When the balloon is inflated, it expands the sides of the mesh stent into the artery walls. This pushes the artery open, restoring blood flow. Because the stent is made of mesh, artery cells grow around it, anchoring it in place. The stent holds open the artery walls. It also helps to prevent pieces of plaque that had been blocking the blood flow from breaking away and possibly causing a heart attack. Balloon angioplasty is sometimes performed without stent placement, where the balloon's outward expansion is adequate to compress the blockage in the artery. Balloon angioplasty is categorized as a nonsurgical procedure: it does not require an incision or general anesthesia, and recovery time for most patients is short.
Coronary Artery Bypass Graft/Surgery
This major surgical procedure typically involves opening the chest and connecting the patient to a heart/lung bypass machine. Less invasive procedures are being developed where small incisions are made in the chest, and medication is used to slow the heart instead of using the bypass machine. A section of blood vessel is removed from a different part of the body. One end is grafted to the aorta (the large artery that carries blood rich with oxygen from the heart to the rest of the body), and the other end is grafted on to the artery just past the blockage, creating a new path for the blood to flow.
Pacemakers
During this minor surgical procedure a small power source, a pacemaker, is placed just under the skin near the heart. The pacemaker maintains a regular heartbeat by sending electrical impulses to the heart.
Ablation
Depending on the heart condition, or combination of heart conditions, ablation may be either a nonsurgical or surgical procedure. Often referred to as radiofrequency ablation, it is used to treat abnormal heart rhythms called arrhythmias. Arrhythmias are caused when the normal flow of electrical impulses in the heart is disrupted. The disruption could be that the impulses are taking the wrong path, or that they have stopped flowing smoothly.
During nonsurgical ablation a catheter is inserted into the affected area of the heart. Radiofrequency energy, which is mild and painless, is passed through the catheter and into small areas of heart muscle that are causing the arrhythmia. The energy disrupts the pathway of the abnormal rhythms and stops them.
Surgical ablation is another way to stop arrhythmias that may be combined with other heart procedures. This procedure creates and utilizes scar tissue. The surgery may be done by creating a large incision in the chest, or through small incisions. Scar tissue is created by making small cuts in the heart muscle, or by using an energy source to make lesions. When the cuts or lesions heal they create scar tissue. It is this scar tissue that blocks the errant electrical impulses.
Stent Placement
A stent is a small, wire mesh tube placed inside a coronary artery. The stent upon expansion pushes open the artery, reestablishing blood flow. It holds open the walls of the artery, giving it support. It helps in keeping pieces of plaque from breaking away and causing a heart attack. A balloon catheter, placed using guide wires, is used to insert the stent into the artery.
Heart Transplant
When all other treatments have failed or the heart is so damaged that it is barely able to function a heart transplant may be considered. The potential recipient is placed on a list and must wait for a donor that is a match. This is a major surgical procedure with many possible postoperative complications.
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Citation and Further Reading:
Department of Health and Human Services / National Institutes of Health / National Heart, Lung, and Blood Institute. 2009. What is coronary angioplasty? URL: http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_All.html (accessed 04/13/2010).
Date of Publication: 09/05/2005
Article Last Updated: 11/17/2011