Ischemic Heart Disease
Ischemic heart disease refers to the recurrence of chest pain or discomfort due to lack of blood received by a particular part of the heart. This condition generally occurs during times of exertion or excitement or when the heart requires greater amounts of blood. Ischemic heart disease (coronary heart disease) is the leading cause of death worldwide and occurs frequently in the United States. It is also the leading cause of death worldwide.
This disease is caused by the accumulation of when cholesterol particles in the blood form on the walls of the arteries that are responsible for supplying blood to the heart. This process eventually leads to deposits (plaques) forming, which eventually block the flow of blood altogether. Because of the decreased blood flow blood flow, the amount of oxygen supplied to the heart is also reduced.
The signs and symptoms of ischemic heart disease tend to develop quite slowly – as arteries gradually become blocked. In some cases or they may occur much quicker, especially if an artery is suddenly blocked. In some cases, people with ischemic heart disease have no noticeable symptoms, while others may have noticeably severe chest pain, know as angina, as well as a shortness of breath. These symptoms can heighten the risk of having a heart attack.
The good news is, lifestyle changes, medicines, and surgical procedures can successfully treat ischemic heart disease. Following heart-healthy practices, such as being physically active and eating low- fat and low-sodium diets, not smoking and maintaining a healthy body weight can greatly improve this condition.
WHAT ARE THE SYMPTOMS OF THIS CONDITION?
Ischemic heart disease can cause a lack of oxygen reaching the heart, due to the reduction of blood flow to the coronary arteries. This reduction in blood flow may result in a number of symptoms such as:
Chest pain, chest pressure, or shortness of breath that:
- Is relieved by medicine or rest
- May feel as if pain coming from the chest and moving out into the arms, back, or other areas
- May feel like indigestion or gas (occurs more frequently in women)
- Occurs frequently; episodes tend to be very similar
- Occurs when the heart is forced to work harder, such as during during physical exertion
- Usually lasts for short periods of time (five minutes or less)
Serious symptoms that might indicate a life-threatening condition
Ischemic heart disease can be life threatening so it is important that you seek immediate medical care if you, or someone you are with, experience any of the following life-threatening symptoms including:
- Angina pectoris (Chest pain typically on the left side of the body)
- Pain in jaw or neck
- Tachypnea – Rapid breathing/shortness of breath
- Shoulder or arm pain
HOW IS THIS CONDITION TREATED?
Taking certain drugs and having certain medical procedures and making lifestyle changes is often how treatment for coronary artery disease usually involves.
Making a commitment to the following healthy lifestyle changes can dramatically improve the health of your arteries.
- Eating healthier
- Regular exercise
- Losing weight
- Reducing stress
- Quit smoking
Various drugs can be used to treat coronary artery disease, including:
- Cholesterol-modifying medications: By decreasing the amount of “bad” (low- density lipoprotein) you have, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor may choose to treat you using different medications, including niacin, statins, fibrates and bile acid sequestrants.
- Aspirin: Taking aspirin daily or other blood thinner may be recommended, thus reducing the likelihood of your blood clotting, which may help prevent obstruction of your coronary arteries. Aspirin can help prevent future attacks from occurring, if you’ve previously had a heart attack. There are some cases where aspirin isn’t appropriate, such as if you suffer from a bleeding disorder or if you’re already taking another blood thinner. If this is the case then consult your doctor before taking aspirin.
- Beta blockers: By slowing your heart rate and decreasing your blood pressure, Beta blockers help to reduce the hearts need for oxygen. If you’ve had a heart attack, these drugs can reduce the risk of future attacks occurring.
- Nitroglycerin: Nitroglycerin sprarys, patches and tablets help control chest pain by temporarily dilating your coronary arteries and reducing your heart’s demandfor blood.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): ACE’s and ARB’s decrease your blood pressure , helping prevent the advancement of coronary artery disease.
Sometimes more aggressive treatment is needed. Here are some options:
- Angioplasty and stent placement (percutaneous coronary revascularization): This procedure involves a long, thin tube (catheter) being inserted into the narrowed part of your artery. A wire with a deflated balloon is then fed through the catheter to the area that is narrowed. Once the balloon is in place, it is inflated, compressing the deposits against your artery walls.
In order to keep the artery open a stent is left there. Some stents also release medication to help keep the artery open.
- Coronary artery bypass surgery: CABG is used to treat people who have very severe coronary heart disease (CHD) as it allows improved blood flow to the heart.
This method essentially creates a new path for blood to flow to the heart with the following steps:
A healthy piece of vein from your leg or a healthy piece of artery from the chest or wrist which is then attached to the coronary artery, just above and below the affected area, thus allowing blood to get around (bypass) the blockage/narrow point.
Although results of this procedure are excellent, sometimes people need more than one bypass. In many cases, people remain symptom-free for many years. Surgery may be required again if blockages form in the grafted arteries or veins or in arteries that weren’t previously blocked. Medicines and lifestyle changes may help prevent arteries from clogging up again.
DIAGNOSTIC SERVICES AVAILABLE
- Consult with doctor and physical exam: During a physical exam, your doctor will check your medical history, perform a physical exam and order a series of blood tests.
- Electrocardiogram (ECG): An ECG records electrical signals as they travel through your heart and can pick up evidence any previous heart attacks or heart dysfunctions. In other cases, Holter monitoring may be required. This type of ECG involves wearing a portable monitor for 24 hours as you go about your normal daily activities. The monitor will detect if you have any abnormalities indicating inadequate blood flow to your heart.
- Echocardiogram: An echocardiogram uses sound waves to produce images of your heart. This test will allow your doctor to see whether all parts of the heart wall are functioning normally normally. If there are any parts moving weakly, this may suggest they’ve been damaged during a heart attack or could be receiving insufficient levels of oxygen or may indicate coronary artery disease or various other conditions.
- Stress test: If your signs and symptoms occur when your exercising, you may be asked to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. If you are unable to exercise then medication to stimulate your heart is used rather than exercise. Some stress tests are done using an echocardiogram. In this case, an ultrasound may be performed before you exercises or your doctor may use medication to stimulate your heart during an echocardiogram. Nuclear stress testing is another method that helps measure the blood flow to your heart muscle, both at rest and during stress and is similar to a routine exercise stress test but with images added to an ECG. You will be injected with a tracer and special cameras are able to detect which areas in your heart that receive less blood flow than others.
- Cardiac catheterization or angiogram: Your doctor may inject a special dye into your coronary arteries through a catheter, in order to view blood flow through your heart. This dye outlines blockages and narrow spots on the X-ray images. If there is a blockage and treatment is required, then a balloon can be passed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) can then be used to keep the dilated artery open.
- Heart scan: Computerized tomography (CT) methods allow your doctor to see calcium deposits in your arteries that can narrow the arteries. Coronary artery disease may be likely if a substantial amount of calcium is discovered. A CT coronary angiogram can also generate images of your heart arteries. This involves re contrast dye being injected intravenously during a CT Scan.