Non-Surgical Treatment Options for Coronary Artery Disease

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• Medical Treatment Effectiveness
• Diagnosis and Treatment Stratification
• Lifestyle Changes and Medication
• Managing Asymptomatic Patients
• Treatment for Symptomatic Patients
• Invasive Treatment Options
• Importance of Second Opinions
• Full Transcript

Medical Treatment Effectiveness

Dr. Dale Adler, MD, explains that medical treatment for coronary artery disease can be as effective as surgical procedures like angioplasty or open-heart surgery. By focusing on drug therapy, patients can significantly reduce their risk of heart attacks and strokes. This approach is particularly beneficial for patients with stable coronary artery disease, where invasive procedures may not be necessary.

Diagnosis and Treatment Stratification

Accurate diagnosis is essential in determining the appropriate treatment for coronary artery disease. Dr. Adler emphasizes the importance of stratifying patients based on their symptoms and diagnostic results. This ensures that each patient receives the most suitable treatment, whether it involves lifestyle changes, medication, or more invasive procedures.

Lifestyle Changes and Medication

For many patients, lifestyle changes and medication can effectively manage coronary artery disease. Dr. Adler highlights the importance of lowering cholesterol levels, controlling blood pressure, and improving blood vessel health through medication. These measures can help prevent the progression of the disease and reduce the likelihood of symptoms developing.

Managing Asymptomatic Patients

Patients with asymptomatic coronary artery disease can often be managed successfully with lifestyle changes and medication. Dr. Adler discusses a study conducted by Intermountain Healthcare, which found that managing risk factors in asymptomatic patients can lead to excellent outcomes. This approach focuses on preventing the development of symptoms and maintaining heart health.

Treatment for Symptomatic Patients

For patients experiencing symptoms such as shortness of breath or chest pain, a more intensive treatment approach may be necessary. Dr. Adler explains that while some symptomatic patients respond well to medication, others may require more aggressive interventions if their heart function remains compromised. Regular monitoring and stress tests can help determine the best course of action.

Invasive Treatment Options

In cases where coronary artery disease is severe, invasive treatments like coronary angioplasty or coronary artery bypass graft (CABG) surgery may be required. Dr. Adler notes that patients with significant heart function impairment or multiple affected arteries often benefit from these procedures. Early intervention can help restore blood flow and improve heart function.

Importance of Second Opinions

Dr. Anton Titov, MD, emphasizes the value of seeking a second medical opinion for coronary artery disease. A second opinion can confirm the accuracy of the diagnosis and ensure that the chosen treatment strategy is the most appropriate for the patient's condition. This step can provide patients with confidence in their treatment plan and improve overall outcomes.

Full Transcript

Dr. Anton Titov, MD: Medical treatment of coronary artery disease is often as effective as angioplasty or open-heart surgery. Correct heart disease diagnosis stratifies a patient to the correct treatment category. Drug therapy for heart diseases reduces risks of heart attack and stroke.

Dr. Anton Titov, MD: How to treat coronary heart disease conservatively? When is medical treatment of coronary heart disease best? Who benefits most from medical treatment for coronary artery disease? When to do angioplasty or interventional procedure in coronary artery disease? What treatment of coronary artery disease works best in my situation?

Dr. Dale Adler, MD: Sometimes we talk about coronary artery heart disease, we always have to separate patients into separate groups. There are patients who may have had a cardiac CT scan. Heart CT shows they have calcium in their coronary arteries. We say appropriately that these patients have coronary artery disease. They have absolutely no symptoms. Sometimes you put them on a treadmill. Then they would perform the running test wonderfully. There is no suggestion even at high workloads that their heart has a problem. That is an ideal group of patients. This is one extreme example of patients with coronary artery disease.

Dr. Dale Adler, MD: We can say about them this: "This is a systemic process. We want to use lifestyle changes. We want to make their cholesterol as low as we can." We are very happy to use beta blockers (medicines) to make sure their blood pressure is perfect. We are very happy to use other medicines that make the linings of their blood vessels better. There is no question about that. That is a group of patients that you can really target and probably help them a lot to stay healthy and prevent symptoms of coronary artery heart disease.

Dr. Dale Adler, MD: Research study was done on such group of asymptomatic coronary artery disease patients. Doctors at Intermountain Healthcare group looked at all their patients with diabetes. And they said this: We are going to do CT scans of the heart on these patients. We are going to look at patients who have known coronary artery disease based on coronary artery calcification. We are going to manage one group of asymptomatic diabetes patients with more invasive therapy. We will do coronary artery angiograms and look at their heart function with technological methods.

Dr. Dale Adler, MD: There was another group of diabetes patients with asymptomatic heart disease. Then doctors focused on managing risk factors for coronary artery disease. This is what the study showed. Sometimes you manage heart disease risks well in this population of asymptomatic patients. Therefore, they can do extremely well.

Dr. Dale Adler, MD: So that part we understand. Now we move to another group of patients. This is the group of patients who have symptoms of coronary artery heart disease. They may have shortness of breath or chest pain with exercise. Sometimes you put these symptomatic patients on a treadmill. Then you will find a problem. There are substantial areas of their heart that are not getting enough blood flow. This situation with symptomatic patients becomes very different from the first group of patients.

Dr. Anton Titov, MD: How to treat them? On one hand, there are still doctors who say this: Look at the clinical trial results. You can treat heart disease risks of these patients very vigorously with medications. Then these patients will do fine. And the answer is that many of such patients will do fine. You just have to be extremely honest in your conclusion that they are doing great.

Dr. Dale Adler, MD: After a period of intensive management of heart disease risks in these patients, you can put them on a treadmill test again. Sometimes their heart is getting plenty of blood flow. But previously these patients had a problem with blood flow. Then these patients are doing well. But some patients will still struggle with their heart function even after you manage all their heart risks. They will still show heart disease symptoms during exercise stress test performance.

Dr. Dale Adler, MD: Then such patients have to be moved to the active treatment group. This was done in the Intermountain Healthcare study. It's time to treat heart disease in such patients more intensively. And there is a third group of patients. They have coronary artery disease that is bad enough correct from the beginning. This group of patients is very interesting. Because these patients are missing a reserve capacity in their heart function.

Dr. Anton Titov, MD: Sometimes some bad event occurred in one coronary artery, they already have problems in other coronary arteries. Therefore their heart will not do so well.

Dr. Dale Adler, MD: Because there is no reserve in their heart's function. So you have to use more invasive, more interventional methods of treatment early in this group of patients. These patients have more severe coronary artery heart disease. You can do coronary angioplasty, coronary artery bypass graft CABG surgery.

Dr. Anton Titov, MD: Can you avoid surgery or angioplasty? Can medical treatment and lifestyle changes be successful in heart disease therapy?