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Treatments

Lifestyle Changes

In some cases, coronary artery disease can be managed with lifestyle changes that include reducing risk factors. These include:

  • Quitting smoking
  • Modifying your diet
  • Keeping your blood pressure under control
  • Exercising (You should check with your doctor before beginning any exercise program.)
  • Reducing stress

Medications

If lifestyle changes aren't enough to control your coronary artery disease, you may need to take one or more medications to help your heart and arteries function better so that you receive sufficient oxygen-rich blood. These include:

Cholesterol-Lowering Drugs

These drugs, often called statins, can decrease the amount of cholesterol in the blood, especially LDL or "bad" cholesterol. The drugs can also increase the amount of HDl or "good" cholesterol. The drugs can reduce the deposits that clog coronary arteries.

Aspirin

Your doctor may recommend you take a daily aspirin tablet or other blood thinner to help reduce the tendency for your blood to clot.

Beta-Blockers

These are drugs that slow your heart rate and lower your blood pressure, reducing your heart's demand for oxygen.

Nitroglycerin

This medication is taken during an angina attack, usually in the form of a tablet placed under your tongue. The drugs control chest pain by opening up the coronary arteries.

Angioplasty and Stenting

If you have a severe blockage in one or more arteries, you may benefit from a procedure known as angioplasty or percutaneous coronary intervention or revascularization (PCI).

Benefits of Procedure

This procedure can:

  • Improve blood flow to your heart
  • Relieve chest pain
  • May be able to prevent a heart attack

Minimally Invasive Procedure

The procedure opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque that is blocking your artery against the artery wall. This widens the artery and restores the flow of blood. A thin wire mesh tube called a stent may be placed in the artery permanently to keep the artery open. Some stents are coated with medication to help keep the artery open.



The procedure is done in the hospital and can take from 30 minutes to three hours. It is done under local anesthesia to numb the area of the groin where the catheter is inserted. Afterwards, you must remain in bed for at least another six hours. You may be able to go home the same day, but more often you will need to spend the night in the hospital.

Watch Video Animation

To watch a video animation of a cornorary angioplasty, click here.

Coronary Artery Bypass Graft (CABG) Surgery


Open-Heart Surgery

In coronary artery bypass graft (CABG) surgery, arteries or veins from other areas in your body are used to bypass or go around your narrowed coronary arteries. CABG can improve blood flow to the heart, relieve pain and possibly prevent a heart attack. A CABG is open-heart surgery. As a result, it is often used in cases where multiple coronary arteries are blocked or where the blockages are not suitable for angioplasty or stenting.

About CABG Surgery

CABG surgery involves exposing the heart through either the breastbone or the ribs. The operation typically included the use of a heart-lung machine, which takes blood from the heart, adds oxygen, and then pumps it back into the body. Your surgeon may take an artery from the chest wall or remove a section of vein from your leg. These vessels are then grafted to the blocked arteries above and below the blocked areas. After the grafts are sewn into place, the heart-lung machine is turned off. The breastbone is wired together and the chest is closed. You are under general anesthesia during the operation.  The CABG operation takes four to five hours.



Post Op

Afterwards, you will be taken to the ICU where you will be on a heart monitor, have a breathing tube in your mouth, and a catheter in your bladder. You will also have temporary pacing wires and drainage tubes in your chest, and have several intravenous catheters in your neck and arms. You will probably remain in the hospital for four to five days and should be able to return to office-type work in four to six weeks. Because the bypass arteries can also clog, you must pay close attention to your diet, take aspirin and other medications as prescribed by your doctor, exercise regularly and maintain a healthy lifestyle to keep this from happening.

Watch Video Animation

To watch a video animation of a Coronary Artery Bypass Graft, click here.

Off-Pump Beating-Heart CABG Surgery

In some cases, your surgeon may want to perform your bypass while your heart is still beating. This operation uses special equipment to stabilize or quiet the heart down while the surgery is ongoing. The heart-lung machine is not used. The remaining details of the surgery are the same as conventional CABG. The goal of off-pump bypass surgery is to decrease the risks associated with the use of the heart lung machine, such as stroke, renal failure and need for blood transfusion. Not everybody is a candidate for off-pump CABG.

Watch Video Animation

To watch a video animation of an Off-Pupm CABG, click here.

Endoscopic or Minimally Invasive CABG Surgery

Traditional CABG surgery -- with or without the use of a heart-lung machine -- requires a large incision dividing the breastbone. In endoscopic CABG surgery, your surgeon performs the bypass through a smaller incision or incisions, using a tiny endoscopic camera and smaller instruments. Also, the heart-lung machine is not used The operation is associated with less post-operative pain, a shorter hospital stay and a shorter recuperation. Not everybody is a candidate for endoscopic CABG. In most cases, it is reserved for those who need just one blocked artery bypassed.

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-8800

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