Heart disease treatment

There are a number of operations available to treat heart disease which range from relatively minor procedures such as angioplasties and the fitting of pacemakers, to heart transplants. When a heart attack is suspected, drugs such as aspirin may be given immediately to improve blood flow through the coronary arteries. Pain relief, oxygen and other treatments may also be given.

When a heart attack has been diagnosed, one of two methods may be used to try to reopen the blocked artery.

Treatments for heart disease aim to do one or more things :

• Drugs that dissolve the blood clots blocking the artery have greatly improved the treatment of heart attacks, although they’re not suitable for everyone. Thrombolytics or 'clot busters', can restore blood flow in about 60 per cent of cases, although sometimes the artery blocks again later on.
• An operation called percutaneous transluminal coronary angioplasty or PCI involves inserting a tube into the coronary arteries. The tube carries a deflated balloon that can be inflated in the blocked area to push against the artery walls and open the vessel. In general, PCI produces slightly better long-term results than thrombolytic drugs but it must be carried out in a specialised centre.

The next step in the treatment is to work out which part of the heart is affected, and how badly. This is done by studying an electrocardiogram (ECG: a trace of the electrical activity in the heart) and other tests, in particular a blood test that measures levels of a chemical called troponin, which is released from damaged heart muscle cells.

There are several different types of heart attack. The area of the heart that's affected has important implications for what sort of complications there may be, how well the patient will recover and the treatment they should be given.

Not so long ago, a heart attack meant weeks of bed rest. Nowadays, people may spend just a few days in hospital, but a much longer process of rehabilitation is important to help the person recover fully, deal with common problems such as depression and reduce the risk of a second attack.

Heart transplants

127 heart transplants were undertaken in the UK in 2008, a fifth on children under the age of 16. Heart transplants are usually carried out on people with severe heart failure caused by coronary heart disease or cardiomyopathy. They can also be carried out for patients with:

• Severe abnormalities of the heart valves.
• Congenital heart defects.
• Uncontrollably fast heart rhythm.

A heart transplant may be offered for a number of reasons, when certain conditions are met:

• The heart muscle has become weakened (cardiomyopathy).
• The heart's blood vessels are blocked and the heart muscle is damaged.
• Apart from heart problems, the individual is in good health.
• Other treatments have been tried or excluded.
• The individual is under 60 (in most cases).
• The individual is able and willing to stick to lifestyle changes necessary after the transplant.

The average wait for a transplant once on the waiting list in the UK is six months. Unfortunately, about 15 per cent per cent of patients die while on the waiting list for a transplant. The heart is stopped and a machine takes over the function of the heart and lungs. The diseased heart is removed and the donor organ sewn in and connected to the main blood vessels.

After a transplant, the individual will need to take immunosuppressive drugs for the rest of their life, to stop their body rejecting the transplant, as well as other drugs to help their body fight infections. The new heart will be monitored at regular intervals for any signs of rejection. After the operation, drugs are given to ensure the body doesn’t try to reject the new heart.

In the past, heart transplants sometimes failed because the person's immune system rejected the transplanted heart. But as techniques have improved and new immunosuppressive drugs have been introduced to prevent rejection, so heart transplants have become more successful.

The majority of people who have a heart transplant can now expect to live for five years or more. Even so, transplant remains an 'end-of-the-line' treatment when all else has failed and the patient is likely to die or have a poor quality of life unless it's done. Unfortunately, a shortage of donors mean that a significant number of people who are waiting for a heart transplant die before a suitable one is found.

Drugs and surgery

Doctors have been treating heart disease for hundreds of years, and now modern drugs mean many people with heart disease can lead a relatively normal life. Treatments for heart disease aim to do one or more things:

• Improve blood flow through the coronary arteries - by dilating the arteries, for example.
• Reduce the build up of atherosclerosis.
• Help the heart muscle to work better, allowing the heart to act more efficiently as a pump.
• Change the electrical control of the heart, so influencing the rhythm, for example by slowing the heart when it beats too fast, or preventing abnormal rhythms, such as atrial fibrillation.
• Thin the blood to improve flow, stop clots from forming and prevent a heart attack.
• Reduce the strain on the heart, for example by controlling blood pressure.

Drugs to treat heart conditions adjust the working of the heart or circulation of the blood.

Most are taken orally as tablets or capsules to be swallowed, but they can also come in the form of tablets held under the tongue, aerosols or patches. Drugs can also be administered directly into a vein or a muscle.

Drug treatments

There are a range of drugs doctors can use to treat heart disease. Many people will find that they're advised to take several different medicines together, depending on the nature of their heart problem and whether they have risk factors such as high blood pressure.

Many heart drugs have minor side-effects, but most settle down in time. Your doctor and/or pharmacist will alert you to any side-effects and what you should do about them, and you'll also find details in the information leaflet that comes with your medication. If you develop any unexpected effects, or if you're worried, contact your doctor.

Aspirin and antiplatelets

These prevent blood clotting in the arteries by reducing the stickiness of blood cells called platelets, which are involved in clotting. This helps to improve blood flow in narrowed coronary arteries and reduces the risk of a blocked artery leading to a heart attack. Aspirin can reduce the risk of dying from a heart attack by 25 per cent or more. These drugs are also used after heart bypass surgery to prevent blood clotting.

Beta blockers

These are used to prevent angina, treat high blood pressure and improve heart failure. They work by blocking the effects of stress hormones, which make your heart beat faster and more forcefully. By slowing the heart and also relaxing the arteries throughout the circulation, the heart doesn’t have to work so hard, which helps in heart failure. Beta blockers also lower the risk of another heart attack if you have already had one, and/or help control abnormal heart rhythms (arrhythmias).

Calcium channel blockers

There are different types of calcium channel blockers and they have differing effects. Some relax and dilate the blood vessels and are used for treating angina, high blood pressure and heart failure, while others slow the rate at which the heart beats and are used to treat abnormal heart rhythms.

Diuretics

These drugs, often referred to as 'water tablets', may be used to control blood pressure or remove excess fluid from the body in heart failure. They act by increasing the excretion of water and sodium by the kidneys.

Nitrates

Nitrates dilate the coronary arteries. This improves blood flow to the heart muscle, which helps to relieve angina. Glyceryl trinitrate (GTN) is a commonly used nitrate. It's in the tiny pills, or spray, that people put under their tongue during an angina attack. Dilation of the arteries reduces the work the heart has to do to pump blood around the body, so nitrates are helpful in heart failure, too.

Statins

These drugs are used to help reduce the amount of cholesterol in the blood. High levels of cholesterol are a risk factor for heart disease. By lowering unhealthy levels of cholesterol, the risk of CHD and heart attacks is reduced.

Thrombolytic drugs

This group of drugs has radically improved the treatment of, and survival from, heart attacks in the past decade. They dissolve clots that form in a coronary artery and trigger heart attacks.

If the drugs are given quickly enough - within a couple of hours of onset of a heart attack - they'll restore the blood flow through the artery in time to avoid permanent damage to the heart muscle. The earlier this treatment's given, the better.

However, because the drug thins the blood it can cause brain haemorrhage (stroke) in a significant number of patients

Heart surgery

Sometimes medication can't control all the symptoms of heart disease. Surgery may be needed to open or replace the blocked arteries, repair damaged valves or simply keep the patient alive.

Common operations for heart disease include:

Coronary angioplasty

Coronary angioplasty where a long, thin, hollow tube or catheter is passed through an incision up into the coronary arteries. A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle. Find out more about coronary heart disease.

Atherectomy

Atherectomy uses a rotating shaver on the end of a catheter, introduced through a blood vessel in the leg or arm, which is fed through to the blocked coronary artery.

Coronary bypass surgery

Coronary bypass surgery, is an operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.

Valve replacement

Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue).

Heart valve replacement

Heart valve surgery may be required if drugs are unable to control the problem.

Cardiac pacemakers

When the electrical system of the heart becomes damaged or faulty, it may be necessary to put in an artificial pacemaker to make the heart beat regularly. This involves on operation to put a wire into the heart, attached to an external device and battery, to deliver electrical signals to the heart.

Rest and recovery

Despite huge advances in heart surgery techniques, recovery can be slow and, in a significant number of cases, a variety of complications ranging from infection to stroke cause long-term problems. The length of time it takes to recover after any of the above procedures depends on the type of surgery, the type of anaesthetic administered, and the age and overall state of health of the patient. It's extremely common to be easily upset and tired for the first three to six months after surgery, so it's important to get plenty of rest.

Likewise, it's extremely important to attend a cardiac rehabilitation programme to attain your optimum level of health and to learn how to modify your lifestyle to minimise the chance of future heart problems. For a small number of patients, depression is a persistent problem.Forgetfulness is also common, but normal memory will usually return after about six months. In some cases, people find they have more persistent problems with aspects of intellectual function, including memory. This may be related to the use of the bypass pump used to circulate blood around the body while the heart is being operated on, which can cause tiny clots that block small arteries in the brain.

After any kind of heart surgery it's extremely important to pay attention to your lifestyle, watch your diet and become more active, to promote recovery and to help improve the health of the heart and blood vessels. A GP or cardiac nurse will be able to advise you.

Driving should be avoided for at least a month after bypass surgery. Contact the Driver and Vehicle Licensing Agency (DVLA) for details.

Rehabilitation is crucial for people who have suffered heart attacks and now have poorer health as a result. Attendance at rehabilitation programmes run by a hospital or another centre usually start four to six weeks after a heart attack and last for around six to eight weeks. Programmes can also be followed at home. The aim is to improve fitness and aid recovery at the same time as improving confidence and quality of life. This is done through exercise, relaxation and information on lifestyles, including diet and risk factors, and treatment.