How Heart Disease Is Treated

How Heart Disease Is Treated By Richard N. Fogoros, MD Medically reviewed by Yasmine S. Ali, MD, MSCI on November 20, 2019 Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Goals by Type Home Remedies and Lifestyle Prescriptions Specialist-Driven Procedures Palliative Care Complementary Medicine (CAM) Since heart disease is a term that encompasses a wide range of heart conditions, treatment depends entirely upon what condition you have. In general, lifestyle changes such as implementing a heart-healthy diet, smoking cessation, exercising, and maintaining a healthy weight are recommended.1 Prescriptions, procedures, or surgeries may also be needed, depending on the type of disease you have and its severity. Some of the major types of heart disease include atherosclerotic disease, cardiac arrhythmias, heart valve disease, heart infections, and heart failure. Types of Heart Disease Verywell / Emily Roberts Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP Goals by Type Treatment goals depend on the type of heart disease you have, as well as how severe your case is. Atherosclerotic Disease Atherosclerotic diseases include coronary artery disease, carotid artery disease, and peripheral artery disease. The goals of treatment are to prevent symptoms, prevent a heart attack, and slow or stop the worsening of your disease.2 Cardiac Arrhythmias Treatment may not be needed for an arrhythmia unless it's creating problems or if it may lead to a more severe arrhythmia or complications. In these cases, treatment will focus on regulating your heartbeat.3 Heart Valve Disease With heart valve disease, your treatment goals will be to protect your heart from more damage, manage your symptoms, and possibly surgically repair any valve problems.3 Heart Infections When you have a heart infection such as endocarditis, pericarditis, or myocarditis, the main goal of treatment is to get rid of the infection and inflammation in your heart, as well as any symptoms you may be having. Heart Failure Heart failure requires lifelong treatment, but this can help you live a longer, better-quality life. The goal is to reduce your symptoms as much as possible while balancing medications and other treatment options. Home Remedies and Lifestyle No matter what type of heart disease you have, your doctor will likely recommend lifestyle changes to help keep your symptoms at bay and prevent your condition from getting worse.4 Smoking Cessation If you smoke, quitting is one of the best things you can do to help your heart health. Smoking can further damage your heart and your blood vessels, as well as contribute to heart arrhythmias and high blood pressure.5 Talk to your doctor about a program to help you quit. Exercise Enough can't be said about the effectiveness of staying active for heart health. Not only does it help to keep your blood pressure and cholesterol lower, it can help you keep diabetes controlled and prevent you from gaining too much weight—all risk factors for developing or worsening heart disease. If you have a heart arrhythmia or a congenital heart defect, you need to talk to your doctor about any potential exercise restrictions before you begin a program. In general, try to get 30 to 60 minutes of exercise on most days. Heart-Healthy Diet Eating a diet that's rich in fruits, vegetables, and whole grains is good for your heart and your weight. Focus on lean sources of protein and fat-free or low-fat dairy products. Watch your cholesterol, fat, salt, and sugar intake too. Weight Control Getting your weight to a normal level can help prevent your heart disease from worsening. Talk to your doctor about what a good range is for you and your body type. In general, aim for a body mass index (BMI) of 24 or under.6 Stress Management Don't let the stress in your life build up. Make sure you take time for yourself and that you have go-to relaxation methods you can use. Meditation, exercise, yoga, journaling, painting, knitting, muscle relaxation, and deep breathing are all great ways to deal with stress. Good Hygiene If you have heart disease, you need to be especially careful to stay away from people who are sick with contagious illnesses. Wash your hands regularly and thoroughly, brush and floss your teeth at least twice a day, and talk to your doctor about getting vaccinated for the flu and pneumonia to help you stay healthy. Maintain Follow-Up Care Be sure to take all of your medications as directed, keep all of your follow-up appointments, and stick to your treatment plan. If you have questions or concerns, talk to your doctor. Treatment plans often have multiple options, so if something isn't working for you, chances are that your doctor can find a different solution. Staying under the regular care of your doctor also helps him or her tell if there's a change in your condition so steps can be taken to get on top of it before it gets out of control. Diabetes Control If you have diabetes, it's important that you keep it well managed. Uncontrolled diabetes can lead to worsening heart disease, as well as other complications.7 Be honest with your doctor about how well you're complying with your treatment so that he or she can come up with the best plan for you. Prescriptions For any type of heart disease, you may need prescription medication to treat your symptoms and decrease the risk of further damage if lifestyle changes aren't enough or if you have a heart infection or heart failure. There are a large number of different medications that your doctor may prescribe. Aldosterone Antagonists These potassium-sparing diuretics are used for heart failure and can help you live longer while improving your symptoms. One potential side effect is dangerously high potassium levels in your blood, so close monitoring by your doctor will be necessary.8 Aldactone (spironolactone) and Inspra (eplerenone) are the two available brands. Angiotensin-Converting Enzyme (ACE) Inhibitors Used to treat heart failure, high blood pressure, heart valve disease, coronary artery disease, myocarditis, and heart attacks, ACE inhibitors work by relaxing your blood vessels, helping your heart to work more efficiently. Potential side effects include a dry cough, high potassium levels in your blood, dizziness, fatigue, headaches, and losing your sense of taste.9 Examples of ACE inhibitors are Lotensin (benazepril), Vasotec (enalapril), Capoten (captopril), and Monopril (fosinopril). Angiotensin II Receptor Blockers These medications are used to treat heart failure, myocarditis, and high blood pressure. They also work by helping your blood vessels dilate so that your heart can work more efficiently and your blood pressure stays within normal limits. Side effects can include dizziness, high potassium levels in your blood, and swelling in your tissues. Examples of angiotensin II receptor blockers include Atacand (candesartan), Teveten (eprosartan), Avapro (irbesartan), and Cozaar (losartan). Angiotensin Receptor Neprilysin Inhibitors (ARNIs) These new drugs are used to treat heart failure. They contain a combination of angiotensin II receptor blockers and neprilysin inhibitors that helps your blood vessels dilate, improve blood flow to your heart, reduce the amount of salt your body retains, and lessen any strain on your heart. Potential side effects are dizziness, lightheadedness, or a cough. The only ARNI that's currently approved by the U.S. Food and Drug Administration (FDA) is Entresto (sacubitril/valsartan). Antiarrhythmic Medications Antiarrhythmic medications help regulate your heartbeat and are used to treat arrhythmias and heart valve disease. Side effects may include taste changes, appetite loss, sensitivity to sunlight, diarrhea, and constipation. Commonly prescribed antiarrhythmics include Cordarone (amiodarone), Tambocor (flecainide), Rhythmol (propafenone), and quinidine. Antibiotics Antibiotics are used to treat heart infections like endocarditis and bacterial pericarditis. Your doctor will do a blood test to see what kind of microbe is causing your infection and prescribe an antibiotic or a combination of them based on the results. You will likely need to get the antibiotics intravenously, which means you'll probably be in the hospital for at least a week. Once your doctor can see that the infection is clearing, you may be able to come in for intravenous (IV) treatments or even do them at home. Anticoagulants Anticoagulants keep blood clots from forming and prevent any blood clots that you have from getting bigger. They're used to treat a type of arrhythmia called atrial fibrillation, heart valve disease, congenital heart defects, and for people who are at risk of a stroke or heart attack. Side effects may include excessive bleeding, dizziness, weakness, hair loss, and rashes. Examples of anticoagulants are Coumadin (warfarin), heparin, Pradaxa (dabigatran), and Eliquis (apixaban). Antiplatelet Agents Antiplatelet agents stop blood clots from forming by preventing the platelets in your blood from sticking together. These are often used for atherosclerotic disease and for people who have had a heart attack, stroke, transient ischemic attacks (TIAs), unstable angina, or certain heart surgeries. Depending on your condition, you may be prescribed two antiplatelet agents. Potential side effects include headaches, dizziness, nausea, constipation, diarrhea, indigestion, abdominal pain, nosebleeds, and bruising easily. Aspirin is an antiplatelet agent, as are Plavix (clopidogrel), Effient (prasugrel), and Brilinta (ticagrelor). Beta Blockers These medications help reduce your blood pressure by blocking epinephrine, which helps your heart beat slowly and less forcefully and your blood vessels dilate. Beta blockers are usually used for high blood pressure, atherosclerotic disease, heart arrhythmias, myocarditis, heart valve disease, heart failure, and heart attacks. Side effects may include cold hands and feet, fatigue, and weight gain.10 Commonly prescribed beta blockers are Sectral (acebutolol), Tenormin (atenolol), Kerlone (betaxolol), and Zebeta (bisoprolol). Calcium Channel Blockers Calcium channel blockers partially block the effect of calcium on heart muscle cells and blood vessels. They can reduce blood pressure and slow down the heart rate. They're used to treat atherosclerotic disease, high blood pressure, and arrhythmias. Side effects can include constipation, headache, perspiration, drowsiness, rash, dizziness, heart palpitations, nausea, and swelling in your feet or legs.11 Typically prescribed calcium channel blockers include Norvasc (amlodipine), Cardizem and Tiazac (diltiazem), Plendil (felodipine), and Sular (nisoldipine). Digitalis Also known as Lanoxin (digoxin), this drug for heart failure and certain heart arrhythmias slows down your heart, decreases symptoms of heart failure, and helps give you a stronger heartbeat. Common potential side effects are dizziness, fainting, and slow or fast heartbeat. Diuretics You've likely heard diuretics referred to as water pills. That's because they prevent fluid and sodium from building up in your body, which decreases the amount of work your heart has to do. These medications are used to treat heart valve disease, myocarditis, atherosclerotic disease, high blood pressure, and heart failure. While they're generally fairly safe, you will probably notice increased urination, which can lead to mineral loss. Other possible side effects include low sodium levels in your blood, dizziness, dehydration, headaches, muscle cramps, joint problems, and erectile dysfunction. Examples of diuretics include Midamor (amiloride), Bumex (bumetanide), Diuril (chlorothiazide), and Hygroton (chlorthalidone). Statins Statins are used to lower cholesterol. They're typically prescribed when you have an atherosclerotic disease to help keep your cholesterol levels within normal limits in order to prevent heart attack and stroke. The most common side effect is muscle pain. Less common side effects are liver damage, increased blood sugar levels, and neurological effects such as confusion or memory loss.12 Examples of statins are Lipitor (atorvastatin), Lescol (fluvastatin), Altoprev (lovastatin), and Zocor (simvastatin). Vasodilators Also known as nitrates, vasodilators lessen your heart's workload by allowing your blood vessels to relax and dilate, increasing blood and oxygen to your heart. Vasodilators are often used to treat heart valve disease, high blood pressure, heart failure, and atherosclerotic disease. Because they can have a lot of side effects, vasodilators are generally only prescribed if other methods aren't working to control your blood pressure. Side effects can include fast heartbeat, heart palpitations, retaining fluid, nausea, vomiting, skin flushing, headaches, more hair growth than normal, and joint or chest pain.13 Commonly prescribed vasodilators include Isordil (isosorbide dinitrate), Natrecor (nesiritide), nitroglycerin tablets, and Apresoline (hydralazine). Specialist-Driven Procedures If lifestyle changes and prescription medications aren't effectively treating your heart disease, your doctor may recommend other options such as surgery, special procedures, or medical devices. Here's an overview of some of the procedures and devices that may be used. Coronary Artery Bypass Graft (CABG) A coronary artery bypass graft (CABG) is used when your heart is blocked.14 In a CABG, the surgeon uses arteries or veins from your leg, arm, or chest to reroute blood around the blockage to your heart, allowing the blood and oxygen to flow more freely so your heart doesn't have to work so hard. A CABG can also help relieve chest pain (angina). You may have one or up to several grafts done, depending upon how much blockage there is. This surgery is used to treat heart failure, atherosclerotic disease, and arrhythmias. Heart Valve Repair or Replacement If you have a heart valve issue, such as can be found in heart valve disease, heart failure, and endocarditis, your doctor may recommend that you have your valve repaired or replaced. Your original valve may be repaired using one of several different methods or it may be replaced with a prosthetic valve if it's irreparable. There are certain heart valve repairs and replacements that can be done without open heart surgery in minimally invasive procedures. Your doctor will decide what the best choice is for you based on your condition. Implantable Cardioverter-Defibrillator (ICD) If you have a heart arrhythmia, your doctor may recommend that you have an implantable cardioverter-defibrillator (ICD) implanted. It goes right under the skin of your chest and has wires that run through your veins to your heart. The ICD monitors your heart rate and gives your heart a shock if it's going too fast or it stops. It can also function as a pacemaker, keeping your heart from beating too slowly. Sometimes people with heart failure or other heart disease end up with arrhythmias, so an ICD may be an option.15 Ventricular Assist Devices (VADs) If your heart is weak and/or you have heart failure, your doctor may want to implant a ventricular assist device (VAD). This device helps your heart pump blood through your body. It can be placed in either of the two ventricles in your heart or in both, but it's most often placed in the left ventricle, in which case it's called an LVAD. A VAD can be used while you're waiting to have a heart transplant, if you're not a good candidate for a heart transplant, or if your doctor expects your heart to regain normal function but it needs help in the meantime. Implantation does require open-heart surgery, so the risks and benefits need to be weighed. For people with severe heart failure, however, it can be a lifesaver.16 Percutaneous Coronary Interventions [PCI] Also known as angioplasty, percutaneous coronary intervention (PCI) involves threading a tube with a deflated balloon attached through your veins up to your coronary arteries. The balloon is then inflated to widen places in your arteries that are blocked to allow the blood to flow through much more freely. This procedure is often combined with the placement of a stent, a wire mesh tube that helps keep the artery open afterward. PCIs can also help lessen chest pain (angina) and open arteries in your neck and brain if you're at risk of having a stroke. Pacemaker Similar to an ICD, a pacemaker is also implanted just under the skin near your collarbone with a wire that runs to your heart. When your heart rate is abnormal, it sends an electrical impulse to your heart to make it beat regularly. Pacemakers are used for people with arrhythmias. Maze Procedure For some types of arrhythmia, a maze procedure works to regulate heart rhythm. The surgeon creates a series of cuts in the upper part of your heart which then scar over, making it difficult for stray electrical impulses to travel through. Endarterectomy For some people with atherosclerotic disease, surgically removing fatty buildup from the artery walls may be necessary to remove a blockage. When this is done on the arteries in your neck, the carotid arteries, it's called carotid endarterectomy. Catheter Ablation This procedure for certain types of arrhythmias involves threading a catheter with an electrode at the tip through your blood vessels to your heart. The catheter is placed in the area of your heart that's giving off the abnormal electrical signal and the electrode ablates, or destroys, a very small amount of tissue there using radiofrequency energy. This creates a block so the signal can no longer get through. Cardioversion Another procedure for certain arrhythmias, particularly atrial fibrillation, your heart is given a shock by using electrodes or paddles on your chest. This forces it to beat in a normal rhythm. Heart Transplant If your heart is severely and irreversibly damaged and other treatments aren't working, you may need a heart transplant, replacing your diseased heart with a healthy heart from an organ donor. A heart transplant can lengthen your life and improve the quality of your life, but it can take a long time to find a suitable donor. Palliative Care Palliative care involves treating the pain, discomfort, side effects of medications, and symptoms of a serious disease, such as heart failure.17 It may be a good choice for you if you have severe heart disease and you're experiencing distressing symptoms that are difficult to control, such as: Chest pain (angina) even when you're resting Shortness of breath (dyspnea) even when you're resting Persistent symptoms, such as swelling in your feet, despite aggressive treatment Inability to tolerate aggressive treatments because of low blood pressure or kidney disease History of heart attacks and/or resuscitation Keep in mind, palliative care can be implemented at any time during the course of your illness and you may want to consider it as soon as you're diagnosed with any serious illness. It's not just for the end of life, though hospice care does always include palliative care. The purpose of palliative care is to help you deal with symptoms, stress, and to improve your quality of life.17 It's used alongside your regular care so you can keep seeing your current doctors. It can prompt all of your healthcare providers to coordinate their care, which gets everyone on the same page. Palliative care can also give you emotional support, help make sure that your wishes are followed, and educate you about your disease. Your palliative care team is personalized and may be made up of a variety of healthcare providers including doctors, nurses, counselors, nutritionists, social workers, pharmacists, and religious or spiritual advisors. Complementary Medicine (CAM) There are several different foods and supplements you can look into adding to your treatment program that may help your heart disease. It's a good idea to talk to your doctor before increasing or adding these to your diet. Flaxseed A number of studies have shown that supplementing your diet with flaxseed may reduce bad cholesterol if your cholesterol is already high.18 This was seen when whole flaxseed or lignan supplements were used, but not flaxseed oil. Multiple studies have also shown that flaxseed supplements can significantly lower your blood pressure.19 You can mix flaxseed with liquids or solids, but talk to your doctor about how much you should consume because ingesting too much can cause problems like constipation and, rarely, bowel obstruction. Flaxseed also might not be good for people with certain health conditions, so check with your doctor first. Omega-3 Fatty Acids The omega-3 fatty acids in fish may help lower your blood pressure a bit, decrease triglycerides, lower your cholesterol, reduce inflammation, and decrease irregular heartbeats. In fact, if you have heart failure, an atherosclerotic disease, or you've recently had a heart attack, the American Heart Association recommends that you take omega-3 fish oil supplements every day to help treat your disease.20 You can get the same benefits from eating fish that are rich in omega-3 fatty acids at least twice a week. Tuna, salmon, mackerel, lake trout, herring, and sardines have the most, but there are other fish that are beneficial as well. It should be noted that omega-3 fatty acids, whether in supplement or food form, won't prevent heart disease. Garlic In a review of studies of the effects of garlic on heart disease, it was found that garlic supplements have the potential to help prevent heart disease, as well as treat it. Although the studies included in the review used different types of garlic preparations, generally garlic powder, aged garlic extract, or garlic oil, in general, it was found that the aged garlic extract had the most consistent effect. Systolic blood pressure and diastolic blood pressure were reduced by 7 to 16 mmHg and 5 to 9 mmHg respectively, and total cholesterol was reduced by 7.4 to 29.8 mg/dL. Additionally, the studies showed that garlic supplementation had a positive effect on risk factors for atherosclerotic disease such as calcium buildup in the coronary arteries, stiffness of the arteries, and a biomarker of inflammation called C-reactive protein.21 Garlic is very safe and is often used to treat high blood pressure in developing countries. The most common side effects are body odor and bad breath, which can be minimized if you take your garlic in capsule form instead of eating it raw. Garlic may also cause some digestive issues like abdominal pain, bloating, gas, and, rarely, allergic reactions. Vitamin D More and more studies are linking vitamin D deficiency to all sorts of kinds of heart disease like heart attack, heart failure, peripheral arterial disease, strokes, and high blood pressure.22 It would naturally follow then that perhaps adding more vitamin D to your diet may help prevent or treat heart disease. Multiple clinical trials are now being done on just that possibility and, so far, the results are encouraging. One study used a form of vitamin D called 1,25-dihydroxyvitamin D3 (1,25D) in mouse heart cells called cardiac colony-forming unit fibroblasts (cCFU-Fs). cCFU-Fs cells begin to replace the cells in tissue that has been inflamed and damaged from oxygen deprivation after a heart attack. This results in scar tissue in your heart that may stop it from pumping blood effectively and can lead to heart failure. The researchers found that the 1,25D was able to stop the cCFU-Fs from forming, so preliminary studies are positive. Of course, as this is animal research, results may not be the same in humans.23 That said, having your doctor check your vitamin D level may be a good idea to make sure you're on track, especially since it has been proven to be good for your bones and there may be an extra cardiovascular benefit. Getting around 10 minutes of a medium amount of summer sun exposure is the best way to boost your levels.