Let's Talk About Heart Disease Treatments and Medications
If your heart needs help, try not to worry. Drug therapies, surgeries, and lifestyle changes are tough to beat.by Matt McMillen Health Writer
Learning you have heart disease might rock your world. Whether your diagnosis is the result of inescapable genetics, long-standing habits, or more likely a little of both, you will probably need to make some big changes in order to improve your heart health and live a longer, more comfortable life. We know that can feel hugely overwhelming, but you don't have to do all by yourself. Medications and procedures exist to help your heart function more like it should, making your new good-for-you habits like eating better and exercising even more powerful. And the really good news? Once you start, you can trigger a positive feedback loop...medication can help you feel better, so you can do more. You do more, so maybe need less medication. See, it can be win-win. You've got this. Here's what you need to know to get started.
Our Pro Panel
We went to some of the nation's top experts in heart disease treatment to bring you the most up-to-date information possible.
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
David Friedman, M.D.
Director of Heart Failure Services
Northwell Health’s LIJ Valley Stream
Long Island, NY
Sometimes. When an underlying condition like an infection has caused heart problems, your heart may return to normal once that condition has been fixed. However, most people who develop heart disease will have it for the rest of their lives. Fortunately, treatments have advanced significantly, as has knowledge of the heart, so there’s more that can be done these days to help you live as close to a normal life as possible.
100% yes! Heart disorders often result from a lifetime of poor diet, lack of exercise, and other habits not so friendly to your heart. No matter what your age, you’ll benefit from taking good care of yourself. The earlier you begin, the better able you’ll be to protect your heart as you get older. Some heart disease risk factors, like advancing age, can’t be changed, so focus on all the things you can do that will make a difference.
The symptoms will depend on the type of heart disease you develop. And not all diseases of the heart have symptoms. HBP and sometimes afib, for example, have no noticeable symptoms. That’s why it is so important to see a doctor on a regular basis so you can get evaluated. It’s also critical to learn the signs of a heart attack, a stroke, and other medical emergencies so that you will know what’s happening and seek help immediately.
You may be eligible for cardiac rehabilitation, a weeks-long medically supervised program that will focus on essentials like teaching you to eat well and providing you with an individualized exercise program tailored to your needs and abilities. Rehab also works with you to develop ways to cope with the stress and other emotional burdens that often accompany heart disease. By addressing your mental health, you’ll be better able to maintain your motivation to care for your physical health. Win-win!
What Is Heart Disease, Anyway?
Heart disease does not refer to a single condition. Instead, it’s a catchall term for a wide range of heart-related disorders that affect how your heart functions.
High Blood Pressure (HBP)
Elevated blood pressure increases your risk for many heart conditions, including coronary artery disease (CAD), atrial fibrillation (often simply called afib), and heart failure. It’s also the leading cause of stroke.
Coronary Artery Disease (CAD)
The most common type of heart disease, CAD is diagnosed when your heart's arteries become partially or fully blocked due to plaque buildup or a blood clot. The end result of either blockage? A heart attack.
Most often the result of CAD, a heart attack, or “myocardial infarction” (to use doctor-speak), occurs when your heart does not receive the oxygen-rich blood it needs to survive. Such an event can quickly cause permanent damage to your heart. Some heart attacks are fatal.
The blood pumped by your heart supplies your body with oxygen. Heart failure occurs when your heart can no longer keep up with your body’s needs. This happens if the heart weakens, stiffens, and/or enlarges from CAD, injury, or too much strain, leaving it unable to work efficiently. As a result, fluid can backflow into the lungs, making it harder to breath.
An arrhythmia is an irregular heartbeat. Many different types of arrhythmias exist, and they can cause your heart to beat too fast, too slow, or erratically. Many arrhythmias are harmless, but some can be deadly because they interfere with your heart’s ability to pump blood to the rest of your body.
Atrial fibrillation falls into this category. The most common arrhythmia, afib can cause clots to form in your heart’s upper chambers. A clot can break away and travel from your heart to your brain, causing a stroke.
When your brain’s oxygen supply gets cut off, that’s a stroke. While technically not a form of heart disease, stroke can be the result of HBP or certain arrythmias. It occurs when an artery is blocked or bursts.
How Is Heart Disease Treated?
Because there are different categories of heart disease, let’s break out treatments by specific heart condition. There can be plenty of overlap between treatment plans—common medications (like beta blockers, for instance) can be used to treat a range of heart ailments. Same goes for certain surgeries and implantable devices.
No matter what type of heart disorder you have, it's important to ease the strain on your ticker by making some key lifestyle changes so you can live a longer life. We’ll cover the essential, non-negotiable part of any successful treatment plan—healthy living—after we detail medications and procedures. Keep reading!
What Treatments Are Available for High Blood Pressure?
Managing your blood pressure means getting it below 120/80. That will ease the burden on your heart and reduce your risk of life-threatening complications like stroke and heart failure. Lifestyle management, detailed later in this article, plays a big role, but you may require medications as well. The different types used include:
Beta blockers. These drugs block the hormone epinephrine, and that slows the heart and allows it to beat less forcefully.
Calcium channel blockers. These meds keep calcium out of the cells in your heart and arteries, allowing blood to flow more easily.
Diuretics. These drugs help rid your body of excess fluid and salt, which relieves blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors. These medications block a chemical called angiotensin and prevent it from narrowing your arteries.
Angiotensin II receptor blockers (ARBs). These drugs, like ACE inhibitors, block angiotensin.
What Treatments Are Available for Coronary Artery Disease?
CAD treatment has several goals: reduce the heart’s workload, improve blood flow, and slow or reverse the buildup of plaque on the walls of your arteries. A range of medications and medical procedures can help. They include:
Medications for Coronary Artery Disease
Many medications exist to help reduce CAD symptoms (like chest pain), as well as slow or prevent the progression of the disease and reduce your chances of a heart attack. There are different types that work in different ways.
Beta blockers. These are quite effective at slowing your heart rate and reducing the force of your heart's contractions, which gives your heart more time to relax between beats.
Calcium channel blockers. Sometimes called calcium channel antagonists, these are used to treat CAD by relaxing your blood vessels to improve blood flow. The same meds prescribed for HBP are commonly used to treat CAD.
Antiplatelets. These drugs (like aspirin) help prevent dangerous blood clots, which can develop around plaque buildups so common in CAD.
Nitrates. This treatment, which includes nitroglycerin, works to dilate, or widen, your arteries that have been narrowed by CAD, which boosts blood flow to your heart and eases chest pain. Nitrates also widen your veins, easing the strain on your heart. They are available as pills, patch, or spray.
Statins. These medications control your cholesterol level, which can limit plaque buildup. Statins may also help clear existing plaque buildups. If you can’t tolerate statins, your doctor can prescribe others types of cholesterol-lowering drugs.
PCSK9 Inhibitors. These drugs lower LDL, or bad, cholesterol. They can be taken on their own or with a statin.
Ranolazine. This drug, frequently prescribed under the brand name Ranexa, helps ease chest pain (angina) that hasn’t responded to other therapies. It improves blood flow, which enables the heart to work more efficiently.
Surgery for Coronary Artery Disease
Blockages in your arteries from CAD may require a procedure to reduce or remove them to get your blood flow back to normal. You’ll be sedated for these procedures, which include:
Coronary artery bypass surgery. In this procedure, a surgeon takes an artery or vein from another part of your body—a leg, forearm, or your chest are all likely places—and uses it to connect your aorta to a point near the blockage in your artery. This reroutes blood flow so that it bypasses the blockage.
Angioplasty and stenting. A cardiologist threads a thin tube called a catheter through a blood vessel, often located in your groin, to the blockage in your artery. Once there, a small balloon is inflated, and that flattens the plaque on the wall of your artery. Next, a stent is placed at the spot. This holds the artery open and allows blood to flow more freely, preventing the collapse of the artery.
What Treatments Are Available for Heart Attack?
The first priority of heart attack treatment is to improve the flow of blood to your heart—stat! Early treatment helps prevent permanent damage to your ticker and increases your odds of survival. Your treatment will be determined in part by the type of heart attack you have. If an artery is not completely blocked and some blood still flows to your heart, medications alone may be all you require. A total blockage will require more significant, surgical interventions.
Medications for Heart Attack
The following types of drugs will be in your doctor’s arsenal:
Antiplatelets. These drugs help prevent dangerous blood clots that can trigger heart attacks.
Anticoagulants. Also referred to as blood thinners, these drugs slow the development of clots; however, they up the odds of significant bleeding if you’re injured.
Nitroglycerin. This medication eases your heart’s workload by boosting the flow of blood. It also reduces chest pain.
Beta blockers. These medications slow your heart rate and reduce the force of your heart's contractions, which gives your heart more time to relax between beats.
Clot busters (thrombolytics). These intravenous drugs break up the clot that’s restricting the flow of blood and causing your heart attack. Treatment typically takes an hour or so.
Pain relievers. You may receive a drug like morphine to lessen your chest pain (angina).
ACE inhibitors. This type of medication lowers your blood pressure and reduces the stress on your heart.
Statins. These medications control your cholesterol levels and help limit plaque buildup. They can also help clear existing plaque buildups.
Non-statins. These medications are used if statins don’t work for you.
Oxygen therapy. If your blood oxygen levels drop below 90% during your heart attack, you will likely receive supplemental oxygen via a mask placed over your face. Normal oxygen levels range from 95% to 100%.
Surgeries for Heart Attack
Depending on the extent of the blockage causing your heart attack, you may need a stent or surgery to restore blood flow. You’ll be sedated for these procedures, which include:
Coronary angioplasty and stenting. This procedure follows right after a cardiac catheterization. Once the catheter reaches the blockage, the cardiologist inflates a tiny balloon at its end, which opens the blood vessel and allows blood flow to resume. At the same time, a metal mesh tube called a stent is placed at the site to keep your artery open and blood flowing.
Coronary artery bypass surgery. Usually a planned procedure, this surgery may be performed during a heart attack, or shortly thereafter. It will depend on the location and number of blockages you have in your arteries. During bypass surgery, the surgeon takes part of a healthy blood vessel from elsewhere your body, such as your lower leg, and attaches it to points on either side of the blockage. This allows blood flow to bypass the obstruction.
What Treatments Are Available for Heart Failure?
The cause of your heart failure will be treated first. If the culprit is an infection, for example, treating that infection may cure your heart failure. Usually, though, you’ll have to live with this condition, which, in all honesty, will likely worsen over time. In addition to addressing other health conditions you have (like diabetes, arrhythmias, and chronic kidney disease), there’s a great deal that you and your doctor can do to curb your symptoms, boost your quality of life, slow the disease, and live longer. Medications, procedures, and lifestyle changes can help.
Medications for Heart Failure
You doctor may prescribe any of the following:
Diuretics. Also referred to as water pills, these help rid your body of excess fluids to reduce swelling and blood pressure.
ACE inhibitors. These reduce fluid retention and lower blood pressure.
Beta blockers. These meds lower blood pressure and reduce stress on the heart.
Angiotensin receptor blockers. These drugs function similarly to ACE inhibitors but don’t cause a cough, a common side effect of those drugs.
Angiotensin receptor neprilysin inhibitors. This is a recent class of drugs. It makes it easier for the heart to pump, and it improves blood flow and can reduce blood pressure.
Digoxin (digitalis). This drug strengthens your heart’s contractions and enables it to pump more blood.
Except for diuretics, these medications have been shown to work primarily for people with weaker hearts rather than those whose heart muscles have stiffened.
Implantable Devices and Surgeries for Heart Failure
Sometimes, to correct and strengthen your heart’s rhythm and ability to pump blood efficiently, invasive intervention is required. These procedures include:
Pacemaker. A pacemaker is a small device that that controls your heartbeat. Your doctor inserts the device under the skin on your chest, then hooks it up to your heart with tiny wires. It steadies your heart rate when it beats too slowly.
Implantable cardioverter defibrillator (ICD). Small, and battery powered, this device is also implanted beneath the skin and connected to your heat with tiny wires. If your heart stops, an ICD will jolt it with electricity to get it beating again.
Left ventricular assist device (LVAD). This implanted mechanical device is a pump that aids your heart’s weakened left ventricle, one of the heart’s two lower chambers, enabling it to pump blood more efficiently. LVADs are often implanted to keep your heart functioning while you wait for a heart transplant.
Heart transplant. For people with severe heart failure, this major surgery removes a diseased heart and replaces it with a healthy one from an organ donor.
What Treatments Are Available for Arrhythmias, Including Atrial Fibrillation?
Many treatment options exist for arrhythmias. The best approach will depend on your specific symptoms. If you have afib, for example, treatment is a top priority to reduce your risk of a stroke, which can be debilitating or even fatal. Sometimes, if a rogue rhythm cannot be corrected with drugs, or if you don’t tolerate medications well, surgical procedures are used to restore a normal heartbeat.
Medications for Arrhythmias
Common medications used to restore your heart beat to normal include:
Beta blockers, calcium channel blockers, and digitalis. These medications slow your heartbeat if your arrhythmia makes it beat too quickly.
Anticoagulants and antiplatelets. These medications prevent clots and lower your risk of stroke.
Antiarrhythmics. This class of medication corrects your heart beat so that it beats normally. You may need to remain in the hospital when you start taking one so that your doctor can determine if it is both safe and effective for you. There are many options, and side effects are wide-ranging (and experienced differently in different people), so if one doesn’t work for you, you may find success with another one.
Rate control medications. These drugs slow a too-rapid heart rate.
Surgeries and Procedures for Arrhythmias
Some people choose surgical intervention to treat arrhythmias, which may, in some cases, cure them of the condition altogether. For instance, a single cardiac ablation has been shown to permanently cure afib in 75% to 80% of people who are in the first stages of atrial fibrillation. For those who must get a second procedure, that rate goes up to 90%, according to recent research.
Catheter ablation. While you are under general anesthesia, a doctor threads a thin tube called a catheter to your heart via a blood vessel, often one in your groin. There, the catheter applies heat or extreme cold to create tiny scars on small areas of your heart. These scars block the path of the faulty electrical signal that’s causing your arrhythmia. Frequently performed to treat supraventricular tachycardia, it also treats atrial fibrillation and atrial flutter.
AV node ablation. A catheter destroys the part of the heart through which electricity passes from your heart’s upper to lower chambers. This corrects your heart beat, but you will require an artificial pacemaker permanently implanted to activate your heart’s lower chambers, or ventricles.
Electrical cardioversion. While you are under sedation, your doctor will shock your heart with a jolt of electricity. This briefly stops your heart’s electrical activity in order to end an episode of afib. You may require an anticoagulant in the weeks before and after the procedure. This cuts your risk of dislodging a blood clot that’s already in your heart, which will prevent a stroke.
Implantable devices. Arrhythmias can’t always be managed with medication and/or ablation or cardioversion, so you may require a different solution—a device that helps control the electrical signaling of your heart, such as a pacemaker. This small device gets implanted below one of your collarbones and wires from it attach to your heart. Those wires send signals that tell your heart to pick up the pace when it beats too slowly due to a bradycardia, a type of arrhythmia that slows your heart beat.
Cardioverter-defibrillator. Slightly larger than a pacemaker but implanted similarly, this device monitors your heart 24/7. If it senses a life-threatening arrhythmia, such as ventricular fibrillation or ventricular tachycardia, it shocks the heart in order to restore a normal heartbeat.
What Treatments Are Available for Stroke?
Treatment will depend on the type of stroke you have. For an ischemic stroke, in which blood flow to the brain becomes blocked, the priority will be restoring that flow. Treating a hemorrhagic stroke, which occurs when an artery bursts, requires getting the bleeding under control and relieving pressure on the brain caused by the bleeding.
Treatments for Ischemic Stroke
Clearing the blockage must be done quickly. An intravenous medication called tPA (short for tissue plasminogen activator) is the most effective tool to break up blood clots that block blood flow. But tPA must be used within 4.5 hours of the start of your symptoms. If more time has passed, the risk of bleeding in your brain rises too high, and tPA becomes no longer safe to use. Once that 4.5 hour closes, drugs that break up clots (called thrombolytics, which include tPA) must be delivered via a catheter threaded through your blood vessels from your groin to the blockage in your brain.
If your block has occurred in one of your brain’s larger arteries, you may benefit from a thrombectomy within 24 hours of the onset of your symptoms. Your doctor threads a catheter from your groin to your brain via your blood vessels and surgically removes the clot.
Antiplatelet drugs, such as aspirin, help prevent the formation of clots. Anticoagulants are another option to prevent clots.
Treatments for Hemorrhagic Stroke
The goal here is to stop the bleeding and to relieve pressure on the brain. You may receive drugs that help clots to form, as well as medications that help lower your blood pressure and the pressure in your brain. Depending on the size and severity of the stroke, you may require surgery to remove the blood that has leaked from the burst blood vessel and to repair the blood vessel. Surgery also may be performed to relieve pressure.
What Lifestyle Changes Should I Make for Heart Disease?
No matter what your diagnosis is, or which medications and procedures you undergo, a big part of your doctor’s prescription plan will focus on lifestyle improvements. Adjusting how you live can be hard work—but the rewards are well worth it. You’ll likely feel better and have more energy for the loved ones in your life, and for all the things you love to do. What’s more, conquering one bad lifestyle habit often helps you overcome other things that need to change. For example, eating better and exercising regularly will help you lose weight and likely lower your blood pressure, too.
Eat a heart-healthy diet
Prioritize quality sleep (and treat sleep apnea if you have it)
Limit alcoholic beverages
Learn to truly relax
The most important takeaway? If your heart needs help, you have the power to ease and manage symptoms through medications, procedures, and healthy lifestyle choices. So, take advantage of all of the above to improve your quality of life—and even extend it.
Heart Disease Treatment (1.): National Heart, Lung, and Blood Institute. (2005). Your Guide to Living Well with Heart Disease. nhlbi.nih.gov/files/docs/public/heart/living_well.pdf (pdf)
Heart Disease Treatment (2.): National Heart, Lung, and Blood Institute. (n.d.). “Coronary Heart Disease.” nhlbi.nih.gov/health-topics/coronary-heart-disease
Heart Disease Treatment (3.): American Medical Association. (2008). American Medical Association Guide to Preventing and Treating Heart Disease. turnerpublishing.com/books/detail/american-medical-association-guide-to-preventing-and-treating-heart-disease/
Coronary Artery Disease Treatment: Cleveland Clinic. (2019). “Coronary Artery Disease Treatments.” my.clevelandclinic.org/health/treatments/16822-coronary-artery-disease-treatments
Heart Attack Treatment: American Heart Association. “Treatment of a Heart Attack.” heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
Heart Failure Treatment: Mann et al. (2015). “Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.” elsevier.com/books/braunwalds-heart-disease-a-textbook-of-cardiovascular-medicine-single-volume/mann/978-1-4557-5134-1
High Blood Pressure Treatment: Merck Manuals. (2019). “Drug Treatment of High Blood Pressure.” merckmanuals.com/home/heart-and-blood-vessel-disorders/high-blood-pressure/drug-treatment-of-high-blood-pressure
Arrhythmia Treatment: The Cleveland Clinic. (2019). “Arrhythmia Treatments.” my.clevelandclinic.org/health/treatments/16751-arrhythmia-treatments
Atrial Fibrillation: Treatment (1). Merck Manuals. (2019). “Atrial Fibrillation.” merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-disorders/atrial-fibrillation
Atrial Fibrillation: Treatment (2). Cedars-Sinai. (n.d.). “Atrial Fibrillation.” cedars-sinai.org/health-library/diseases-and-conditions/a/atrial-fibrillation.html
Stroke Treatment: American Stroke Association. (n.d.). “Stroke Treatment.” stroke.org/en/about-stroke/treatment