In the early stages of cardiovascular disease, treatment may be a matter of lifestyle modifications aimed at reversing, slowing, or stopping its progression. If lifestyle modifications prove inadequate or the condition has already progressed, your doctor may recommend drug therapy. Surgical intervention or a non-surgical procedure may be necessary in the case of a cardiovascular event, or if diagnostic testing shows that the risk of such an event is quite high.

The lifestyle modifications recommended once a cardiovascular condition is diagnosed are the same as those recommended for cardiovascular disease risk reduction. The difference, in many cases, is the extent of the modification necessary to affect real change in the disease process.

• Stop Smoking — If you smoke, quit. There is no grey area here. Some people assume that once they have been diagnosed with cardiovascular disease, the damage is done, and there is no reason to stop smoking. This assumption is false.
• Eat Healthfully — Changing your dietary habits can help your reduce risk factors—such as high cholesterol, high blood pressure, and excess body weight—for a cardiovascular event. Once you’ve been diagnosed with cardiovascular disease, you will be advised to more strictly limit your intake of saturated fat and salt compared to when you were simply at risk.
• Physical Activity — Resting is the worst way to manage CVD. Even patients who have suffered a heart attack should eventually begin exercising. Since patients with heart disease carry certain risks when they exercise vigorously, your doctor is likely to recommend a thorough evaluation, including an exercise tolerance test, prior to embarking on an exercise program.
• Drink in Moderation — If you already drink, moderate intake of alcoholic beverages (no more than one drink per day for women, two for men) could reduce your risk for many cardiovascular events. However, if you do not drink alcohol, there is no compelling reason is start after you’ve been diagnosed with CVD.
• Maintain a Healthy Weight — Maintaining a healthy weight can help keep your cardiovascular disease under control. Weight loss and maintenance should be achieved through a combination of diet and exercise, under the supervision of your physician.

Medications are often used alone, or in combination, to treat or control cardiovascular conditions. Talk to your doctor about side effects and possible interactions with food, dietary supplements (such as herbs) and other drugs you are taking. The following is a list of the major drugs used to treat cardiovascular disease, a brief description of how they work, and the major drug classes within those categories.

• Anti-arrhythmics —These drugs work to stabilize the electrical conduction system of the heart. Your doctor will decide what drug class(es) to prescribe, depending on the type and severity of arrhythmia, any associated symptoms and your general medical condition. The classes of drugs used to treat arrhythmias include:
  • Sodium channel blockers, such as amiodarone and propafenone
  • Beta blockers, such as acebutolol and propranolol
  • Action-potential prolonging agents, such as sotalol
  • Calcium channel blockers, such as verapamil
• Anti-anginals —These medications alleviate or prevent angina by helping to restore the balance between the heart’s supply and demand of oxygen.
  • Nitrates and nitrites, such as the commonly prescribed nitroglycerin.
  • Beta blockers, such as atenolol and propranolol.
  • Calcium-channel Blockers, such as nifedipine and amlodipine.
• Anticoagulants —Anticoagulants are used to prevent strokes and heart attacks in those at increased risk due to arrhythmias, artificial or diseased heart valves, clot-inducing devices inside blood vessels, or previous cardiovascular events. They prevent clots from forming or inhibit existing clots from growing. However, they cannot dissolve clots that already exist.
  • Coumadin (warfarin) and heparin are two commonly prescribed anticoagulants.
• Medications to Treat Congestive Heart Failure —Your doctor may prescribe one or a combination of these drugs to treat heart failure. All of these drugs are designed to increase the amount of blood the heart can eject with each beat.
  • Angiotensin converting enzyme (ACE) inhibitors, such as enalapril and ramipril
  • Angiotensin receptor blockers (ARBs), such as candasartan and valsartan
  • Beta blockers, such as bisoprolol and metoprolol
  • Inotropic agents such as digoxin and digitoxin
  • Loop diuretics, such as furosemide and bumetanide
• Thrombolytic Agents —Also known as tissue-type plasminogen activators (t-PA), thrombolytic agents are used to dissolve clots that have formed in blood vessels. They are administered during heart attacks to dissolve the offending clot and restore blood flow to the affected heart muscle, minimizing the damage done to it.
  • Streptokinase and anistreplase are examples of thrombolytic agents

Most of the medications used to reduce the risk of cardiovascular disease are also used in its treatment. These include:

• Antihypertensives
• Cholesterol-lowering drugs
• Hypoglycemic agents
• Antiplatelets

Surgical or nonsurgical procedures are often necessary to treat cardiovascular conditions. Some may be scheduled electively while others are performed urgently in response to a cardiovascular event or results from a diagnostic procedure that indicate a cardiovascular event is imminent.

• Abdominal Aortic Aneurysm Repair — An abdominal aortic aneurysm (AAA) is a bulge in the portion of the aorta where it passes though the abdomen carrying blood to the abdominal organs, pelvis, and legs. This procedure, which involves removal of the blood clot in the aneurysm and repair of the aorta wall, is undertaken when an AAA grows too large or ruptures. In some situations, a stent (wire mesh) is inserted into the aorta to treat the aneurysm.
• Cardioversion — Cardioversion is used to correct an abnormal heartbeat. When the arrhythmia is not imminently dangerous or uncomfortable, cardioversion can be done gradually with anti-arrhythmic medications. Under less stable circumstances, prompt electrical cardioversion is necessary. This is accomplished by delivering an electrical charge through electrodes or paddles placed on the chest. This causes a brief interruption in the heart beat, giving the conduction system a chance to reset itself.
• Carotid Endarterectomy — This surgical procedure is used to remove atherosclerotic plaques from the carotid artery, which carries blood to the brain. It is often done to reduce the risk of a stroke in patients who have had transient stoke-like symptoms (transient ischemic attack). The artery on either side is cut open, cleaned out and repaired with sutures. In some situations, a stent is inserted into the carotid artery to treat the blocked artery.
• Coronary Angioplasty — Coronary angioplasty is used to restore blood flow in a blocked coronary artery.

  Balloon Angioplasty

  

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  It is done during a cardiac catheterization procedure in which a balloon at the tip of the catheter is quickly inflated and deflated to open the vessel. Often, a stent is inserted into the vessel to keep it from narrowing again in the future. This technique is also applied to arterial blockages elsewhere in the body, most notably the legs, but may be used in the aorta or carotid arteries, as described above.
• Coronary Artery Bypass Graft (CABG) Surgery — This procedure is used to restore blood flow to the heart, particularly if there are severe or multiple blockages in several coronary arteries. In this procedure, surgeons reroute the blood flow around the blockages by grafting vessels from another part of the body (usually the saphenous vein in the leg) into the coronary circulation. This surgery is traditionally done after patients are placed on a heart-lung machine (which takes over the function of those organs) and the heart is stopped. To avoid this elaborate step, some surgeons have recently begun to perform CABG surgery on beating hearts in certain cases.
• Coronary Stenting — This procedure is done in conjunction with coronary angioplasty. Once a catheter with a balloon at the tip is inserted into a blocked vessel, a small mesh tube called a stent is placed at the tip of the catheter. The balloon is inflated, opening up the blocked vessel, and also expanding the stent. The stent, which is sometimes medicated with anticoagulant medication (blood thinners), remains in the blood vessel to prevent it from narrowing again in the future.
• Femoropopliteal Bypass Surgery — Similar to a CABG procedure, this surgery is used to bypass a blocked artery in the leg, restoring proper blood flow to the lower leg and foot. Doctors use a vein from another part of the body or an artificial vessel to graft around the blocked artery.
• Heart-lung Transplant — This last-resort procedure is used to remove extremely diseased and damaged lungs and heart and to replace them with healthy organs donated by someone who has died. This is most commonly performed on people with severe pulmonary hypertension. During this procedure, the doctors divert the patient’s circulation to a heart-lung machine, which takes over the functions of those organs. They then remove the patient’s lungs and most of the heart and replace them with the donor lungs and heart in the patient’s open chest, Finally, they connect the donor heart and lungs to the patient’s blood vessels, detach the heart-lung machine and restore the patient’s natural circulation.
• Heart Transplant — A heart transplant is done to replace a diseased and damaged heart with a healthy heart donated by someone who has died. It is usually reserved for patients whose congestive heart failure and severely and s disabling and life-threatening, and when all other treatments have been exhausted. During a heart transplant, the patient’s own circulation is rerouted to a heart-lung machine. All except the back wall of the upper chamber of the patient’s heart is removed. The donor heart is attached, connected to the patient’s blood vessels and the heart-lung machine is disconnected.
• Heart Valve Replacement — During this procedure, damaged valves (that are either too stiff to allow blood to flow freely or too leaky to keep blood flowing in one direction) are replaced with artificial or transplanted valves. Doctors perform open-heart surgery to remove the damaged valve, and suture in the replacement valve.
• Pacemaker Insertion — An artificial pacemaker is inserted when the body’s natural pacemaker—the sinoatrial (SA) node—or other parts of the conduction system no longer work properly. The artificial pacemaker maintains the normal heartbeat by automatically sending electrical impulses to the heart when it detects an abnormal rhythm. It is inserted through an incision beneath the collarbone. Wires from the pacemaker are then inserted through a vein to reach the heart.

  Pacemaker Insertion

  

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• Implantable Defibrillator —Implantable defibrillators are similar to pacemakers in that they are implanted to correct an abnormal heartbeat. But where a pacemaker generally corrects heartbeats that are too slow, a defibrillator corrects heartbeats that are too fast. In particular, the defibrillator intervenes with an instantaneous pulse of electricity to reset the heart beat when it detects a life-threatening arrhythmia referred to as ventricular fibrillation. The defibrillator is implanted during a minor surgical procedure.
• Biventricular Pacemaker —A treatment for heart failure that uses a three-lead biventricular pacemaker implanted in the chest. The pacemaker sends tiny electrical impulses to the heart muscle to coordinate (resynchronize) the pumping of the chambers of the heart, improving the heart’s pumping efficiency. Both ventricles are paced to contract at the same time. This can reduce the symptoms of heart failure.