What is "Medical Management" of Coronary Artery Disease?


So your doctor told you that you have Coronary Artery Disease and that he wants to treat it medically…… You start to think…..Isn't he a doctor?......Isn't medicine what he does?......What the heck does he mean by that? And as you turn to ask him you realize that in your hesitation he has left the room. So you ask the nurse and she tells you quickly before running out the door that it means is the doctor either does not feel that the patient needs surgery or that he does not feel that the patient would be a good candidate for surgery (for example a 94 year old with chronic lung disease might not even make it through surgery). If it isn't obvious which reason the doctor has, you can always ask.

Medical management of coronary artery disease includes both lifestyle changes and medications. Lifestyle changes means changing your personal habits to reduce the risk factors of coronary artery disease such as obesity, lack of exercise, stress and smoking tobacco. It also means controlling chronic diseases such as hypertension, diabetes and high cholesterol through diet, exercise and medications. The medications you doctor might prescribe for you in addition to your current medications are:

1) Anti-platelets: This medication helps to prevent blood clots from forming and causing blockage in the arteries that supply blood to your heart.

2) Cholesterol lowering medications. Sometimes diet alone cannot reduce your cholesterol levels.

There are four specific blood tests that your doctor might run to determine which medication will help you the most. There are several types of cholesterol lowering medications:

Bile acid sequestrants: These drugs work in the intestines to help increase the removal of cholesterol through the feces.

Nicotinic acid: This drug works to lower triglycerides and LDL cholesterol, and raise HDL ("good") cholesterol.

Statins these drugs are very effective for lowering LDL ("bad") cholesterol levels and have very few immediate side effects.

Fibrates: Taking these medications in conjunction with modifying your diet can help reduce your LDL ("bad") cholesterol levels dramatically.

3) Beta-blockers are used to decrease your heart rate and reduce the amount of oxygen your heart needs to work.

4) Calcium-channel blockers are used to control chest pain and reduce blood pressure by relaxing the arteries in the body including the coronary arteries, this reduces the workload and oxygen needs of the heart. 5) ACE inhibitors (to control hypertension). The doctor may use other medications instead of ACE inhibitors because the have adverse reactions to many other medications.

6) Diuretics (for excess fluid retention and to control hypertension)

7) Nitroglycerine: these you will use when you are having chest pain. This medication opens up the coronary arteries to improve blood flow to the heart.


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