There are always things that the doctor and patient can do to improve symptoms when one has a coronary blockage, or a narrowed artery to the heart. I can't emphasize enough the importance of both the health care provider AND the patient working together, so the patient feels better in the short term and does better in the long term.

There are three options in treating the symptoms of a blocked artery which causes chest discomfort and/or shortness of breath with exertion (this symptom is called angina). One is medication; two is PCI - Percutaneous Coronary Intervention, or Angioplasty; and three is CABG or Coronary Artery Bypass Graft surgery.

There are a variety of medications that help you live more comfortably and be able to be more active if your blocked artery is causing symptoms. They include beta blockers, which slow the heart rate and decrease oxygen utilization in the heart muscle; calcium channel blockers, which lower heart work through decreasing blood pressure and help the coronary arteries dilate to get the heart more blood; nitrates, which are also vasodilators; and a medication called ranolazine, which improves coronary symptoms through its action directly on the heart muscle.

PCI is a procedure (also called angioplasty) that is performed through a catheter placed in the arteries, where the blocked artery is first stretched open with a balloon. Then a stent (a 2.5 to 5 mm diameter slotted tube)is inserted into the artery to hold it open. This procedure can dramatically improve symptoms.

CABG surgery is performed when there are too many narrow segments to fix with PCI, or there are totally occluded vessels that cannot likely be fixed with PCI, or the nature of the narrow spots make it safer to fix with a bypass operation. In this major surgery, new veins are put in place to literally bypass the blocked coronary arteries.

Which of these three treatments is best for you is a very individualized decision, based on the nature of the blockages, your activity level, your age, your risk factors for complications, as well as the level of your symptoms.

Whichever initial treatment is done, it is critical to stabilize or reverse the cholesterol build-up in the coronary arteries. To do this, the patient must eat a healthy diet and exercise. Taking a baby aspirin a day to prevent blood clots forming in a narrow vessel is standard. Getting your cholesterol to superb levels, often with the help of a statin medication, is also important. Statins have been shown over and over again in large studies to improve both short and long-term outcomes. Stopping cigarette smoking is a must and so is controlling your high blood pressure.