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.
How to treat coronary heart disease conservatively? Dr. Anton Titov, MD. When medical treatment of coronary heart disease is 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? Medical treatment of patients with stable coronary artery disease. Video interview with top expert in cardiology. Second medical opinion ensures that coronary artery disease diagnosis is correct and complete. Second medical opinion also helps to choose the best treatment strategy for coronary heart disease. Seek medical second opinion on coronary artery disease and be confident that your treatment is the best. Coronary heart disease prognosis and therapy. Medical Second Opinion. Dr. Anton Titov, MD. Treatment of coronary heart disease often focuses on invasive methods. Use of technology is always trendy. Procedures are lucrative for private physician practices. But some studies show that medical treatment of coronary heart disease often can be as effective as surgical and endovascular intervention. Dr. Anton Titov, MD. How do you treat coronary artery heart disease conservatively in your clinical practice? What are the latest advances in medical management of heart disease? Second Opinion (Cardiologist, Professor of Medicine, Harvard Medical School). 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 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. That is an ideal group. 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. 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. 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. After 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 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. Medical treatment for Coronary artery disease. Dr. Anton Titov, MD. Can you avoid surgery or angioplasty? Can medical treatment and lifestyle changes be successful in heart disease therapy?