Ischemic Heart Disease: Causes, Sign and Symptoms, Diagnosis, Complications and Treatment

Introduction

The most beautiful organ of human body, the Heart, pumps the blood through blood vessels (arteries) across the whole body parts. To function properly the heart needs oxygen supply promptly. The arteries that supply the blood to heart are called as coronary arteries.

Readers before we go to the deeps of ischemic heart disease (IHD) you have to know the following terms avidly:

• ISCHEMIA: It is the decreased blood flow or oxygen supply to the tissue
• CARDIAC OUTPUT: Cardiac output is the amount of blood a heart pumps in a minute of time. 5-6 liters in a minute is normal.
• HEMOGLOBLIN:  It is an iron-containing protein in red blood cells that carries oxygen to its destination. If your hemoglobin is below the normal range you are an Anemic person, required amount of oxygen transport could not be delivered. Normal range of hemoglobin in males is 14-17 while in females it is 12-16.
• OXYGEN SATURATION: Oxygen saturation is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin in the blood. Normal oxygen saturation (arterial) is approximately 75 to 100 mm of Hg.
• HAEMATOCRIT: It the percentage of red blood cell volume in your blood. Average Hematocrit is 45%.
• ATHERLOSCLEROSIS: Atherosclerosis is the hardening of the arteries because of plaque builds up in the artery. Major cause of IHD.
• THROMBUS: A blood clot formed from platelets and other elements; that forms in a blood vessel, and causes thrombosis or obstruction of a vessel. 

Lets come to our concerned topic, Ischemic Heart Disease (IHD), it is one of the common health problem in our society.

Ischemic Heart Disease (IHD) or Coronary Heart Disease

Ischemic heart disease is actually the imbalance between coronary (heart) oxygen demand and supply, resulting from insufficient blood flow. In almost all the cases the decreased blood flow to the heart is caused by coronary atherosclerotic disease.

Oxygen supply to heart depends on Cardiac Output, Hemoglobin and Oxygen saturation. If one of these somehow decreased you would be suffering from Ischemic heart disease. We can say that oxygen supply to the heart is directly proportional to the above factors.

How does it develop and progress?

The coronary blood vessels inner lining is cloaked up by lipid stuff resulting in plaque formation, over time this plaque my rupture leading to activation of coagulation cascade (blood clotting mechanism) forming a thrombus that eventually occlude the lumen of coronary vessels. This whole pathology leads to narrowing of artery and finally decreased blood flow to the heart i.e. oxygen supply.

Clinical Features

What signs and symptoms you would experience if you are suffering from Ischemic heart disease?

 The signs and symptoms don't frequently appears because these develop over time as your arteries keep narrowing in the presence of risk factors and causes. Initially recurrent chest pain and discomfort symptoms occur on exertion and excitement.

 Risk Factors

The risk factors for ischemic heart disease are further subdivided in major modifiable and major unmodifiable factors.

Major Modifiable Risk Factors

These are the factors you can change at your will. 

• Elevated cholesterol levels: As the blood cholesterol level increases the risk for IHD increases. The concentration of Lipid fractions, especially Low-density lipoprotein (LDL) and High-density lipoprotein are also important. LDL is the single most important subgroup that carries risk for IHD. Patients with coronary artery disease must have to maintain LDL below 100mg. The patients with both coronary artery disease and Diabetes Mellitus maintain LDL below 70mg. Other risk factor included are; low HDL cholesterol, hypertriglyceridemia, increases total-to-HDL-cholesterol ratio and increased Lipoprotein A.
• Tobacco: Cigarette smoking is an important factor for IHD because a smoker's risk of heart attack is 2 times greater that of a non-smoker. If you quit cigarette smoking, after 2 years of cessation you will add 3-4 years in your life expectancy. Passive smoking also increases the risk of heart disease.
•   Hypertension: Most common risk factor for IHD. Blood pressure of 120/80-140/90 mm of Hg is normal. Blood pressure above it leads to cardiovascular diseases. Blood pressure below 130/80 mm of Hg for Diabetic and kidney failure patients is recommended to elude the complication of heart diseases.
• Lack of Physical Inactivity and Exercise: Inactivity and sedentary life are risk factors of IHD. If you practice exercise daily, it helps you to increase HDL cholesterol (called as good cholesterol) and control diabetes and obesity, as well as lowers blood pressure.
• Obesity: Patient with increased body fat particularly at waist area, are more likely to develop IHD and stroke.
• Diabetes Mellitus: It is the most dangerous risk factor. Almost 75% of diabetic patients die of some form of cardiovascular disease.

Major Unmodifiable Risk Factors

These are the factors you can’t change.

• Age: Men >45 and women >55 are at high risk to develop IHD.
• Family History: Coronary heart disease in first degree relatives is a significant risk factor.
• Gender: Men have a greater risk for IHD than woman.  

What to do to prevent oneself from the above risk factors?

Aggressive treatment of hypertension and cholesterol, as well as regular physical activity and glycemic (diabetic) control, definitely reduces the risk for developing Ischemic heart disease.

 

STABLE ANGINA

Angina means chest pain related to heart. Stable angina is typical a chest pain (substernal) that occurs on exertion or exercise and relieves at rest. It is because of myocardial (heart muscle) ischemia. Pain may radiate to jaw, neck, shoulders, or left arm. It may be associated with nausea, vomiting, sweating or lightheadedness.

 

Investigation and Diagnosis

• Resting ECG: Most commonly during an attack ST-segment depression and T-wave inversion is seen on ECG.
• Exercise treadmill test (exercise stress test): In this test the ECG is recorded before, during, and after exercise on a treadmill. If you test positive for stress test, you should undergo cardiac catheterization. 

What if a patient can't exercise?

In these patients chemical stress testing is done at resting, that stimulate the heart as if patient was exercising. These are;

• Dipyridamole stress test
• Dobutamine stress test

Other types of stress test include;

• Nuclear stress test 
• Adenosine stress test
• Stress Echocardiography

Echocardiography detects the myocardial ischemia and infarction (complete loss of blood supply)

 

Treatment and Management

• Antiplatelet Therapy: These medications prevent the formation of clot. Aspirin and Clopidogrel are the examples. Patients who can't tolerate Aspirin, Clopidogrel is recommended for them.
• Anti-anginal Therapy: These decrease the workload to heart. 

1.     Nitrates

2.     Beta blockers

3.     Calcium channel blockers 

4.     Potassium channel blockers 

• Statins: These are Lipid lowering agents
• Revascularization Therapy, includes Percutaneous Coronary Angiography (PCI) in this procedure a stent is placed at the site of obstruction/narrowing in the artery, it keeps it open, and Coronary Artery Bypass Grafting (CABG) this surgical process involves the construction of one or more grafts between arterial and coronary circulations thus bypassing the obstructed artery.

Complications of Ischemic Heart Disease

• Unstable angina
• Arrhythmia (abnormal heart beat)
• Heart Failure
• Heart attack (myocardial ischemia)

Advice: DON'T use the above mentioned treatment methods, if you have any complaints consult your doctor immediately.

What should I have to do when an old family member gets a heart attack and complains of severe heavy chest pain?

Any one in your family gets a heart attack and complains of severe chest pain, without wasting a second give them Aspirin (not recommended in ulcer patients) and sub-lingual nitrates. As they reduce the mortality. And call for emergency.

To readers;

1. Is the topic helpful to you? Let me know in comment section.

Have a great and healthy life ahead

SHARE COMMENT SUBSCRIBE 👍