Ischemic Heart Disease (IHD)

Definition

Ischemic heart disease (IHD) is a medical condition characterized by chest pain with or without exertion and difficulty breathing due to reduced blood supply to the heart muscle. The most common cause of ischemic heart disease is atherosclerosis as the blood supplying arteries to the heart muscles become narrow due to fat deposits. The risk of ischemic heart disease increases commonly in advanced age, long term diabetes, smoking, family history and high blood pressure.

Stable ischemic heart disease presents as stable angina which is relieved by taking rest and drugs whereas unstable ischemic heart disease presents as unstable angina where pain does not subside with rest. It can lead to a heart attack (myocardial infarction) because of death of heart muscle cells due to long term interruption of blood flow (ischemia). Ischemic heart disease is one most common cause of death and hospitalization.

Symptoms

The symptoms of ischemic heart disease includes :

  • Chest pain (angina pectoris) is where the pain is usually precipitated by exertion both physical and mental. The pain usually occurs on the left side of chest but may spread to left arms, upper abdomen, neck, back and jaw. The patient often describes the pain as heaviness, tightening of chest or crushing sensation.
  • Profuse sweating
  • Apprehensiveness and anxiety
  • Breathing difficulty
  • Rhythm disturbances (irregular pulse)

Sometimes the chest pain does not subside with rest or by intake of nitrates. This may be an indication of a heart attack. Patients suffering from unstable angina are at greater risk of suffering from heart attack. Patients may suffer from shock characterized by cold, clammy limbs and drop in blood pressure.

Causes

The heart is the organ which supplies oxygen and other nutrients via the blood to different organs of the body. Blood is also supplied via the coronary arteries to the muscular heart wall which is an oxygen and nutrient demanding organ. Atherosclerosis is a pathological condition when there is narrowing of arteries of the body due to fat deposits on the inner walls of the arteries. A defect in fat metabolism characterized by raised cholesterol levels, specifically elevated levels of “bad cholesterol” LDL and fall in “good cholesterol” HDL levels in the blood, are the main causes behind atherosclerosis.

Fatty deposits in the coronary arteries lead to narrowing and consequent reduced blood supply to the heart muscles. During stressful conditions the oxygen demand of different organs is increased which requires the heart to pump more blood. Therefore the demand of heart muscles is also increased. However, due to narrowing of coronary arteries the demand of heart is hardly met leading to symptoms of ischemic heart disease. The fatty deposits form plaques on the inner walls of the arteries which may rupture leading to clot formation. This may completely block blood flow through already narrowed coronary arteries and thereby leading to symptoms of heart attack.

Risk factors

  • Advanced age
  • High blood lipids
  • Hypertension (high blood pressure)
  • Diabetes mellitus
  • Men and women after menopause
  • Family history
  • Smoking
  • Chronic alcoholism
  • Obesity
  • Stress
  • Sedentary lifestyle

Treatment

One of the main goals of ischemic heart disease is to avoid a heart attack. The condition should be prevented from progressing further and the narrowing reversed as far as possible. This can be done with a combination of lifestyle modification, medication and surgical procedures.

Lifestyle

  • Quit smoking.
  • Regular exercise.
  • Weight reduction.
  • Dietary modification particularly with a low fat diet.

Drugs

  • Nitrates to widen arteries.
  • Beta blockers and other antihypertensive drugs to reduce blood pressure.
  • Antiplatelets to prevent clotting.
  • Cholesterol lowering drugs to prevent and reverse the fatty plaques in the artery wall.

Surgery

Angioplasty and stenting inserts a wire mesh to keep the artery widened. Coronary artery bypass establishes an alternative path for blood flow around the blockage. These measures may be done to prevent a heart attack.

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