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Sunday, 24 November 2013

Coronary heart disease Treatments In conventional medicine

Cardiovascular Disease
Cardiovascular disease is defined as medical conditions affecting the cardiovascular system, including heart, blood vessels(arteries and veins).
I. Coronary heart disease
Coronary heart disease is defined as a condition of narrowing coronary arteries that lead to blockage of the blood flow in the arteries as a result of hardening arterial wall, cholesterol building up in the arteries, chemicals, such as cadmium clog up arteries, etc. affecting the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is the leading cause of death in the United States.
E.1. In conventional medicine perspective
The aims of the treatment of Coronary heart disease (CHD) is to provide enough blood supply to the heart for oxygen demand, and prevent worsening of the disease. But if if you have blood pressure, diabetes, or high cholesterol levels, you may be asked to take certain medicines to prevent coronary artery disease or prevent coronary artery disease from getting worse.
1. Medication and over counter medicine to treat symptoms of the disease
1.1. Aspirin
a. Many researchers believe that daily intake aspirin can reduce the risk of blood clots from forming in your arteries. In the study to determine the cardiovascular and coronary risk thresholds at which aspirin for primary prevention of coronary heart disease is safe and worthwhile, Dr. Sanmuganathan PS and the research team at the Royal Hallamshire Hospital, indicated that Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk >/= 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk(88).
b. Side effects are not limit to
b.1. Stomach pains
b.2. Feelings of nausea 
b.3. Vomiting.
b.4. Allergic reaction to some people
b.5. Aspirin may interact with other medicine, such as blood thinning medicine
b.6. Etc.
1.2. Beta-blockers
a. Beta blocker has been used to lower heart rate, blood pressure, and enhance oxygen to the heart. In the study of The 248 cases presented with new coronary heart disease from 1982 through 1984, and the 737 controls were a probability sample of health maintenance organization patients free of coronary heart disease. A withdrawal syndrome immediately following the cessation of beta-blocker use may be an acute precipitant of angina and myocardial infarction in hypertensive patients who have no prior history of coronary heart disease(89).
b. Side effects are not limit to
b.1. the medicine can cause allergic reaction to certain people, such as: rash, itching, swelling, dizziness, trouble breathing.
b.2. Easy bruising or bleeding,
b.3. Swollen hands or feet,
b.4. Confusion,
b.5. Depression
b.6. Etc,
1.3. Nitroglycerin
a. Nitroglycerin is used to treat ischemic cardiac pain. and improve blood flow to the heart. Transdermal nitrate delivery systems improve the quality of life in ambulant patients: anginal attacks are reduced with a minimum of side effects. The widespread acceptance of this novel form of drug delivery has stimulated its application in other therapeutic avenues. The efficacy of transdermal nitroglycerin in the suppression of silent ischemic attacks has been demonstrated(90)
b. Side effects are not limit to
b.1. Dizziness
b.2. Lightheadedness, or fainting when sitting up or standing
b.3. Flushing of face and neck
b.4. Headache
b.5. Irritation
b.6. Nausea
b.7. Vomiting
b.8. Etc.
1.4. Calcium channel blockers
a. The medicine used to relax arteries, lower blood pressure, and reduce strain on the heart. Researchers suggested that Compared with clopidogrel without calcium-channel blockers (CCBs), clopidogrel with CCB does not increase the mortality or composite thromboembolic events in elderly CAD patients, but clopidogrel combined with nondihydropyridine CCB is associated with significantly increased composite thromboembolic events in comparison with dihydropyridine CCB(91).
b. Side effects are not limit to
b.1. Stomach pain
b.2. Constipation
b.3. Drowsiness
b.4. Fatigue Feelings of a rapidly or forcefully beating heart (palpitations)
b.5. Flushing or hot flashes
b.6. Headaches
b.7. Nausea
b.8. Etc.
1.5. Statins
a. The medicine used to lower cholesterol. Dr. Biasucci LM,  and the scientists at the Sacro Cuore University, in the study ofStatins and coronary artery disease:clinical evidence and future perspective said
“The introduction of more powerful statins in the market offered the opportunity to study whether an intensive lipid lowering treatment could yields even better cardiovascular outcomes than a moderate statin therapy and several clinical trial confirmed this hypothesis. Statins have also pleiotropic effect behind their lipid lowering function: they reduce inflammation, which plays an important role in the atherosclerotic process”(92).
b. Side effects are limit to
b.1. Headache   
b.2. Nausea   
b.3. Vomiting    
b.4. Constipation    
b.5. Diarrhea
b.6. Weakness  
b.7. Muscle pain
b.8. Etc.
1.6. Etc.
 Some researchers suggested that Statin medication can be reduced on the basis of adverse effects only. Angiotensin convertase inhibitor medication is often forgotten in coronary artery disease patients who have undergone cardiac infarction or a temporary stage of cardiac insufficiency. Long-acting nitrate is not the first-line antianginal treatment, beta-blockers and calcium channel blockers being recommended instead.
2. Minimally invasive surgical methods
2.1. Coronary angioplasty (PTCA)
Coronary angioplasty (PTCA) is a procedure used to open narrow or blocked coronary (heart) arteries to restore blood flow to the heart muscle. 2.2. Stent
A stent is a small mesh tube that’s used to treat narrow or weak arteries by improving blood flow and help prevent the arteries from bursting.
2.3. Atherectomy
Atherectomy is a minimally invasive surgical method of  involving the removal of he plaque burden within the vessel, but it has also been used to treat coronary artery disease, albeit ineffectively
2.4. Brachytherapy
Brachytherapy is a minimally invasive surgical method use of a type of energy, called ionizing radiation, to clear the blockage of the arteries.
2.5. Etc.
3. Surgery
Surgery may be necessary for certain patient depending to the severity of the disease or ineffective to the treatment of medication or minimally invasive surgical methods.
3.1. Coronary artery bypass grafting (CABG)
Coronary artery bypass grafting (CABG) is a surgical procedure performed to reduce the risk of death from coronary artery disease by bypass atherosclerotic narrowings as arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries  to improve the blood supply to the heart muscle.  some researchers suggested that transthoracic echocardiography(TEE)  prior to coronary artery bypass surgery can provides higher resolution images than transthoracic echocardiography (TTE). Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment(93).
3.2. Off-pump bypass surgery
Sometimes surgeons can perform open heart surgery without using a bypass pump. In the comparison of Coronary-artery bypass grafting (CABG) has traditionally been performed with the use of cardiopulmonary bypass (on-pump CABG). CABG without cardiopulmonary bypass (off-pump CABG) might reduce the number of complications related to the heart-lung machine, showed that At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources(94).
3.3. Minimally invasive direct coronary artery bypass (CAB)
Minimally invasive direct coronary artery bypass (CAB) is is a surgical procedure performed if only the front or right coronary arteries need bypass by replacing the blocked artery with an artery from the chest  without opening your chest to detour the blockage. The surgical treatment rapidly gaining acceptance in the field of cardiac surgery. The advantages of decreased morbidity, shorter hospital stays, and recovery time are appealing to patients and surgeons(95)
3.4. Transmyocardial laser revascularization (TMR)
Indirect revascularization is a therapeutic approach in case of severe angina not suitable for percutaneous or surgical revascularization. Transmyocardial revascularization (TMR) is one of the techniques used for indirect revascularization and it allows to create transmyocardial channels by a laser energy bundle delivered on left ventricular epicardial surface. Benefits of the procedure are related mainly to the angiogenesis caused by inflammation and secondly to the destruction of the nervous fibers of the heart. TMR is a safe and feasible procedure and it offers a therapeutic solution in case of untreatable angina. Moreover, it could be a hybrid approach for patients undergoing CABGs in case of absence of vessels suitable for surgical approach in limited areas of the heart(96).
3.5. Etc.


Sourecs
(88) http://www.ncbi.nlm.nih.gov/pubmed/11179262
(89) http://www.ncbi.nlm.nih.gov/pubmed/1968518
(90) http://www.ncbi.nlm.nih.gov/pubmed/3088957
(91) http://www.ncbi.nlm.nih.gov/pubmed/22543122
(92) http://www.ncbi.nlm.nih.gov/pubmed/22495163
(93) http://www.ncbi.nlm.nih.gov/pubmed/22614701
(94) http://www.ncbi.nlm.nih.gov/pubmed/19890125
(95) http://jtcs.ctsnetjournals.org/cgi/content/full/113/2/411
(96) http://www.ncbi.nlm.nih.gov/pubmed/22217372