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What is Ischemic Heart Disease?

Ischemic Heart Disease (IHD) refers to the situations in which the heart gets lesser blood supply compared to what it needs. It is mainly due to some pathology in the coronary arteries (the arteries supplying the heart muscle with blood, oxygen and nutrients).

The heart muscle is supplied by three major coronary arteries. Sometimes cholesterol containing plaques get deposited in these arteries and thus the arteries get thickened and narrowed (atherosclerosis). Thus the blood flow to the heart decreases and it may result in angina (chest pain). Sometimes a clot might be formed in these arteries blocking them completely leading to a heart attack.

However, the changes leading to interrupted blood flow to the heart occur very slowly over several decades. Hence the symptoms of IHD occur only when there is a significant reduction in the blood supply to the heart. You need to consult a doctor immediately once you notice any symptoms.

Types

Ischemic heart diseases include:

  • Stable angina:This is chest pain on exertion after or during exercise. The pain is relieved by rest.
  • Unstable angina:This occurs due to spasm of coronary arteries and causes chest pain which is not relieved by rest.
  • Myocardial infarction:Known as heart attack in layman terms, it is a condition where lack of blood supply causes permanent damage to the heart muscle.
  • Sudden cardiac death:Cardiac arrest is sudden loss of blood supply to the heart due to lack of the heart to effectively pump blood. If not treated within several minutes, it usually leads to death.

How common is Ischemic Heart Disease?

IHD is the most common cause of death worldwide and in India there are more than 10 million cases diagnosed per year.

What are the symptoms of Ischemic Heart Disease?

  • Chest pain: There is a tightness in the chest which usually occurs after exercise or emotional stress and goes away after rest.
  • Heart attack: Classical symptoms include a crushing pain or tightness in the chest. The pain radiates to the left arm or left shoulder or left part of the jaw. It is usually accompanied by shortness of breath, sweating and anxiety.

Who is at risk for Ischemic Heart Disease?

Risk factors of IHD are as follows:

  • Male gender: Males are more susceptible to atherosclerosis and IHD as the female sex hormone oestrogen is cardioprotective. Women become susceptible to IHD post menopause
  • Increasing age: Arteries become less elastic and narrowed as age increases.
  • Genetics: Risk of IHD is higher in people with a family history of heart problems.
  • High blood pressure: High BP causes mechanical injury to arteries and thus precipitates clot formation and narrowing
  • High blood cholesterol (specifically LDL): Cholesterol gets deposited on the injured intima (innermost layer of the arterial wall) forming plaques which narrow the arteries.
  • Smoking: Nicotine which is a constituent of cigarette smoke causes direct injury to the intima
  • Obesity: Central obesity, hypertension and type 2 diabetes mellitus together constitute the metabolic syndrome and increase a person’s risk of developing coronary artery disease and stroke
  • Diabetes
  • Sedentary lifestyle
  • Fatty diet
  • Stress: It has become the main factor contributing to increased IHD cases nowadays.

What are the causes of Ischemic Heart Disease?

Ischemic Heart Disease occurs due to narrowing of coronary arteries which follows damage to the inner wall of the arteries. Major causes are as follows:

  • Smoking
  • High blood pressure
  • High blood cholesterol
  • Emotional Stress
  • Diabetes

What are the complications of Ischemic Heart Disease?

  • Heart attack:Complete blockage of blood supply to the heart can cause a heart attack.
  • Heart failure:If some areas of the heart are deprived of oxygen and nutrients for prolonged periods, the heart muscle my become too weak and fail to pump adequate blood to all organs.
  • Arrhythmia:Inadequate blood supply can cause abnormal heart rhythms as well. Arrhythmias are the main cause of sudden cardiac deaths.

How is Ischemic Heart Disease treated?

Non pharmacological treatment:

  • Smoking cessation
  • Healthy fat free, low salt diet
  • Regular exercise
  • Weight reduction
  • Yoga and meditation in order to reduce stress
  • Adequate water intake
  • Plenty of fresh seasonal fruits

Pharmacological treatment:

Drugs:

  • Nitrates (GTN, Isosorbide mononitrate): Nitrates dilate systemic veins and coronary arteries and thus reduce the workload on the heart.
  • ACE inhibitors (Enalapril, Captopril): These drugs reduce the BP and thus prevent progression of IHD.
  • Calcium channel blockers (Amlodipine): They reduce the BP as well as dilate the coronaries.
  • Beta blockers (Propranolol, Atenolol): Beta blockers reduce the BP. They also decrease the heart rate and thus reduce the cardiac workload.
  • Statins (Atorvastatin, Rosuvastatin): These drugs reduce the cholesterol in the body and they also stabilise the atheromatous plaques in the arteries and therefore prevent heart attacks.
  • Aspirin: Aspirin (a blood thinner) prevents platelet aggregation and clot formation and thus prevents a heart attack.
  • Fibrinolytics (Alteplase, Tenecteplase, Streptokinase): These drugs, commonly called clot busters, are used after a heart attack to break the clot blocking a coronary artery.

Procedures:

  • Percutaneous coronary angioplasty: A catheter with a balloon is inserted in the narrowed coronary artery and the balloon is inflated in order to dilate the narrowed portion. A medicated stent is then left in the artery in order to keep it open.
  • Coronary artery bypass grafting: This is an open heart surgery in which the blocked coronary arteries are bypassed using a graft (which is another artery from the patient’s body).

What lifestyle changes are required in managing Ischemic Heart Disease?

  • Diet: Eat a healthy diet low in cholesterol and saturated fats. Include more fresh fruits and vegetables in the diet
  • Exercise: Exercise keeps the heart healthy and happy and avoids risks of further complications. Include minimum 30 minutes of activity a day
  • Quit smoking: Smoking is toxic to the heart and blood vessels. Give it up for a healthier heart
  • Manage stress: Anxiety, depression and stress have all been linked to heart diseases. Find ways to restore inner peace and take up activities to stay busy

How to take care of someone with Ischemic Heart Disease?

  • Encourage them to lead a healthy lifestyle
  • Help them manage their diet
  • Take them for timely check-ups with the doctor
  • Help them to be active and go for a walk together

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