An ischemic heart disease occurs when the blood flow to the heart muscles is reduced as a result of narrowing or blocking of the coronary arteries. The coronary arteries supply oxygen and nutrients to the heart muscle. In the United States, ischemia is the most common form of heart disease and the leading cause of death. It causes chest pain, shortness of breath, and heart attacks. Lifestyle changes, medications, and sometimes surgery can prevent and treat ischemic heart disease.
Ischemic heart disease is primarily caused by atherosclerosis, a buildup of fatty deposits (plaque) on the inner walls of coronary arteries. When plaque hardens and narrows the arteries, blood flow to the heart muscle is reduced. A ruptured plaque can also cause blood clots to form that block the arteries completely, leading to a heart attack, which is the death of a part of the heart muscle.
Some factors that can increase the risk of developing atherosclerosis and ischemic heart disease are:
High blood pressure
High cholesterol
Diabetes
Smoking
Obesity
Physical inactivity
Family history of heart disease
Age
Gender (men are more likely to develop ischemic heart disease than women)
Stress
The most common symptom of ischemic heart disease is angina, which is chest pain or discomfort caused when the heart muscle doesn't get enough blood and oxygen. In addition to feeling pressure, tightness, squeezing, or burning, angina can radiate to the arms, shoulders, neck, jaw, or back. When angina occurs, it is usually caused by physical exertion, emotional stress, or exposure to cold weather. Medications such as nitroglycerin can help relieve it.
There are two types of angina:
Stable angina, which occurs predictably and regularly with a certain level of activity or stress. It usually lasts for a few minutes and goes away with rest or medication.
Unstable angina, which occurs unpredictably and irregularly, even at rest or with minimal activity. It can last longer and be more severe than stable angina. It can also be a sign of an impending heart attack and requires immediate medical attention.
Another symptom of ischemic heart disease is a heart attack, which is a medical emergency that occurs when the blood flow to a part of the heart muscle is completely cut off. A heart attack can cause:
Severe and persistent chest pain or discomfort that does not go away with rest or medication
Shortness of breath
Sweating
Nausea or vomiting
Dizziness or fainting
Palpitations or irregular heartbeat
Anxiety or fear
Some people may not have any symptoms of ischemic heart disease or may have mild or atypical symptoms, such as fatigue, indigestion, or back pain. Women, older adults, and diabetics are more likely to experience silent ischemia, which can be detected by an electrocardiogram (ECG) or stress test.
To diagnose ischemic heart disease, your doctor will ask you about your medical history, symptoms, and risk factors. They will also perform a physical examination and check your blood pressure, pulse, and heart sounds. They may also order some tests, such as:
Electrocardiogram (ECG), which records the electrical activity of the heart and can show signs of ischemia, heart attack, or arrhythmia (abnormal heartbeat).
Blood tests, which can measure the levels of certain enzymes, proteins, or markers that indicate heart damage or inflammation.
Chest X-ray, which can show the size and shape of the heart and lungs and can detect fluid buildup or other abnormalities.
Echocardiogram, which uses sound waves to create images of the heart and can measure its function, structure, and blood flow.
Stress test, which involves exercising or taking a medication that makes the heart work harder while monitoring the ECG, blood pressure, and symptoms. It can show how the heart responds to stress and can detect signs of ischemia or reduced blood flow.
Coronary angiogram, which involves inserting a thin tube (catheter) into an artery in the groin or arm and advancing it to the heart. A dye is injected through the catheter and X-rays are taken to show the blood flow and blockages in the coronary arteries.
Other imaging tests, such as computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or nuclear scan, which can provide more detailed information about the heart and the coronary arteries.
The treatment of ischemic heart disease aims to improve the blood flow to the heart muscle, relieve the symptoms, prevent complications, and reduce the risk of future heart attacks. The treatment may include:
Lifestyle changes, such as quitting smoking, eating a healthy diet, exercising regularly, managing stress, and controlling blood pressure, cholesterol, and diabetes.
Medications, such as:
Antiplatelet or anticoagulant drugs, which prevent blood clots from forming or growing in the coronary arteries.
Nitrates, which relax and widen the coronary arteries and reduce the workload of the heart.
Beta blockers, which lower the heart rate and blood pressure and reduce the oxygen demand of the heart.
Calcium channel blockers, which relax and widen the coronary arteries and lower the blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which lower the blood pressure and prevent the narrowing of the coronary arteries.
Statins, which lower the cholesterol levels and prevent the formation of plaque in the coronary arteries.
Other drugs, such as ranolazine, ivabradine, or trimetazidine, which improve the energy metabolism and function of the heart muscle.
A percutaneous coronary intervention (PCI) involves inserting a catheter and inflating a balloon into a blocked or narrowed coronary artery. A stent, which is a metal mesh tube, may be placed in the artery to keep it open. This procedure can improve blood flow and relieve the symptoms of ischemic heart disease.
During coronary artery bypass grafting (CABG), a healthy blood vessel is taken from another part of the body, like the chest, leg, or arm, and attached to the heart to bypass a blocked or narrowed coronary artery. It can improve blood flow and reduce the risk of heart attacks.
You can prevent or reduce the risk of ischemic heart disease by:
Avoiding or quitting smoking, which damages the lining of the arteries and increases the risk of plaque formation and blood clots.
Eating a healthy diet that is low in saturated fat, trans fat, cholesterol, salt, and added sugars, as well as high in fruits, vegetables, whole grains, lean proteins, and healthy fats, can help lower blood pressure, cholesterol, and blood sugar levels.
Keeping a healthy weight, lowering blood pressure, cholesterol, and blood sugar levels, and strengthening the heart muscle are all benefits of exercising regularly. Ideally, you should engage in 150 minutes of moderately intense aerobic activity a week or 75 minutes of vigorously intense aerobic activity a week.
The best way to cope with stress is to find healthy ways to cope with it, such as meditation, yoga, breathing exercises, hobbies, or counseling.
Keeping blood pressure, cholesterol, and diabetes under control, which can damage the arteries and increase the risk of ischemic heart disease. Follow your doctor's advice on medications, diet, and lifestyle changes.
The use of aspirin can prevent blood clots from forming in coronary arteries and reduce the risk of heart attacks. However, aspirin can also cause bleeding and other side effects, so consult your doctor before taking it.
Following up with your doctor regularly, who can monitor your heart health and adjust your treatment plan as needed.
