Treatment

Treating Atherosclerosis

Currently no treatment reverses the processes of advanced atherosclerosis. There is hope, however, from a recent American study, that is particular drugs combined with a low fat, low cholesterol, low salt diet, may prove effective. Walls of arterial blood vessels cannot be made more elastic. Deposits of lipids or plaque cannot be dissolved.

           Once atherosclerosis is diagnosed, treatment concentrates on preventing the condition getting worse. Medication may be used to enlarge less affected blood vessels, and thus replace some of the lost blood supply. In severe cases of atherosclerosis, surgery may be performed to replaced diseased arterial blood vessels with less affected affected blood vessels removed from another part of the body. In some cases, artificial materials have been used to replace damaged blood vessels, using "bypass surgery".

*Drugs*

            The pain of angina pectoris is treated using the drug glyceryl trinitrate which may be taken orally, held under the tongue, or strapped onto the chest as an impregnated disc or strap, to be absorbed gradually through the skin.

*Pacemaker*

When there are problems with the regularity of heartbeat, an artificial pacemaker can be used to gaincontrol over the electrical activity of the heart. A pacemaker has two basic components, a pulsegenerator containing a power source and one or two pacing leads, each with an electrode on its tip.


Pacemaking can be temporary or permanent. When long-term control over the heart is required, apermanent pacemaker is implanted under the skin. The two most common mode of pacing are:


• Demand this detects the heart’s own rhythms and stimulates depolarization of the heart muscle, andtherefore contraction, as necessary;
• Fixed rate this fires at a predetermined rate, irrespective of the heart’s own activity.


The pacemaker is a small, metal unit weighing between 30 and 130g. It is powered by a lithiumbattery with a life-span of up to 15 years. It is implanted in the chest under local anaesthetic.

*Heart Transplant Surgery*

In cases of heart disease where all other treatments are inadequate or in appropriate, a heart transplantmay be advised. The first heart transplant was carried out in 1967 in South Africa. At first, survival rates were low, but great improvements in drugs used to prevent rejection have resulted in the majorityof transplant patients surviving more than five years. 


The operation itself is relatively simple, with lifebeing sustained by a heart-lung machine during the operation. The difficult task is caring for thepatient afterwards, and relatively few institutions are equipped to do this. Although a relativelycommon procedure, demand greatly exceeds the supply of donor hearts. 


Attempts to develop artificialhearts have not been successful. The latest proposal to meet the demand is to use hearts from pigswhich have been genetically engineered to avoid the potential rejection problems. This not only raises animal rights issues but the possibility of transferring disease from one species to another. 

Treating Stroke

The level of medical care you will receive can vary from place to place. The amount of care you will need depends on how severe the stroke was. If you arrive at a hospital within 3 hours after the first sign of a stroke, the doctor there may give you a thrombolytic medicine right away, to dissolve any blood clots in your arteries. However the choice of treatment will depend on the exact cause of the stroke.

To diagnose what type of stroke you have had, doctors will take your medical history, examine you, and perform tests such as computerized tomography (CT) and magnetic resonance imaging (MRI). These tests will show whether you have had an ischaemic stroke (caused by a blockage) or an intracerebral haemorrhage (caused by a burst blood vessel in the brain).

The doctor will probably prescribe medicines to help relieve your symptoms and prevent future strokes, and give you advice on changing your lifestyle to lower your risk. If you take this advice, you will get the best possible results. Listen carefully to your doctor’s instructions and ask questions if you need to.

For some patients, special surgical procedures to open up the blockage of neck arteries, such as carotid endarterectomy or stenting, can help prevent future strokes.

Rehabilitation and long-term care

Patients who become paralysed following a stroke need special care in hospital to help them recover and to avoid complications and long-term disability.

Most patients who have a stroke are left with some physical disability and may need long-term care at home.

A large part of stroke rehabilitation involves teaching patients how to exercise safely. It also includes:

• helping to improve walking, eating, dressing, bathing, cooking, reading, writing and going to the toilet.

• speech therapy.

• checking to make sure that patients can live safely at home.

• helping to organize medical and rehabilitative care and schedules.

• counselling patients and families, including advice about managing money, legal, and business affairs.

• occupational therapy to help patients stay active and involved.

• physiotherapy to help get back movement.

Medicines used to treat and manage stroke patients

Medicines often used to treat stroke include:

• antiplatelet agents, such as aspirin.

• anticoagulants or blood thinners, such as warfarin.

• medicines to control blood pressure, such as calcium-channel blockers, and angiotensin converting enzyme inhibitors. 

• medicines to lower blood fats.

These medicines must be used under a doctor’s supervision.