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Drug therapy with Nitrates, which dilate the diseased coronary arteries, administered sub-lingually are very effective in relieving the pain in a few minutes. Drugs such as Isosorbide Dinitrate and Isosorbide Mononitrate belong to the category of Nitrates. These drugs are also used as a prophylactic to prevent the pain from occurring. Beta-blockers like Propranolol are also highly effective in relieving pain by reducing myocardial oxygen demand, mainly by decreasing the heart rate. Calcium channel antagonists produce vasodilatation and relieve the symptoms by reducing the excitability and conductivity of cardiac muscle and by reducing blood pressure. For patients with hypercholesterolaemia, drugs may be used to lower cholesterol levels.

Surgical therapy is indicated when medical treatment has failed to relieve symptoms or when the Angiogram shows significant disease in the blood vessels. Coronary Angioplasty – dilating the blocked vessel by inflating a balloon inside the vessel and Coronary Artery Bypass Grafting (CABG) – replacing the blocked area of the vessel using a graft from the patient, may be done to relieve the blockage.

The indications for bypass surgery are increasingly becoming limited. This is due to the growing realization that except in selected cases, bypass surgery only helps to improve the quality of life and relieve symptoms. It does not significantly increase life expectancy. The current trends are to focus on medical treatment and techniques like angioplasty. With proper treatment, most patients will be able to lead normal and healthy lives. Treatment also involves advice regarding regular exercise, avoiding smoking, diet control and life style modification. Good control of diabetesand hypertension significantly improves the outlook.

Ischemic heart disease is one of the most important international public health problems. Population aging and steady improvements in the treatments available for acute coronary syndromes means that more people are now living longer with coronary artery disease (CAD). Therefore advanced ischemic heart disease, defined as heart disease caused by coronary atherosclerosis resulting in significant heart failure (HF), signs and symptoms of intractable angina, and thus severely limits on lifestyle or longevity, is becoming increasingly prevalent. Therapy is clearly challenging, but new advances are making effective therapy of these patients truly possible.

Treatment of Advanced Ischemic Heart Disease, rather than looking at single specific disease states such as CAD or HF, focuses on the concept of the patient who has progressed to advanced states of ischemic heart disease. The Editors have assembled a group of expert contributors to assess the current guidelines and address the practical challenges of managing patients with advanced ischemic heart disease. The book also describes the basic mechanisms of the progression of HF due to CAD and assesses the therapeutic options available in this patient group. Treatment options and protocols are emphasized, making this an ideal practical reference for the practicing cardiology clinician and interventional cardiologist as well as the basic or clinical researcher and student of cardiovascular medicine.

Surgical Treatment:According to the American Heart Association, if medical treatment is insufficient, surgical procedures can include balloon angioplasty, in which the surgeons inserts a plastic catheter in the groin area and threads it up into the coronary vessels to the blockage and inflates a balloon to open the vessel. The surgeon may also insert a mesh metallic tube, called a stent, to keep the artery open. If the blockage area is large or multiple areas are blocked, the surgeon may do a bypass graft in which a vein from another part of the body, such as the leg, is removed and used to replace the blocked coronary artery.

A wide range of medications are used to treat ischemic coronary heart disease, depending upon the severity and the complications. Initial treatment usually includes vasodilators (such as nitroglycerin) to dilate (open) the arteries and improve blood flow, medications to lower cholesterol and reduce plaque formation (such as statins) and diuretics (water pills) to reduce high blood pressure.

Current approaches to the treatment of ischemic heart disease (such as CABG surgery and angioplasty techniques) often result in incomplete revascularization because of the frequent presence of diffuse coronary artery disease extending into small peripheral vessels. As an alternative to these techniques, recent attention has been directed toward harnessing the body’s ability to generate new blood vessels (natural angiogenesis). This report documents the results of animal and clinical studies that evaluated the ability of fibroblast growth factor (FGF-1), produced using genetic engineering techniques, to induce angiogenesis.

After production, purification, and demonstration of the potential for triggering angiogenesis in animal models with FGF-1, a clinical study was performed in 40 patients with multivessel coronary artery disease referred for CABG. All patients had proximal disease of the left anterior descending artery (LAD) as well as disease in the distal one third of the LAD or at the origin of one of its branches. The mean ejection fraction was 50 percent. Between three and four bypass grafts were placed in each patient. FGF-1 was injected into the myocardium distal to the proximal LAD anastomoses in 20 patients. The remaining 20 patients had heat-denatured FGF-1 substituted for FGF-1.