Ischemic heart disease is one of the most common cardiovascular diseases. Also known as coronary artery disease, it occurs when blood flow to the heart muscle is reduced due to a partial or total blockage of the coronary arteries. These arteries are responsible for supplying oxygen-rich blood to the heart so that it functions properly.
This blockage is usually due to the accumulation of plaque, composed of cholesterol, fats, and other substances, on the arterial walls, a process known as arteriosclerosis. This buildup of plaque narrows the arteries and makes it difficult for blood to flow, which can cause chest pain (angina), shortness of breath, and, in severe cases, a heart attack.
Symptoms of ischemic heart disease
The symptoms of ischemic heart disease can vary from person to person, and some people may not experience any symptoms in the initial stages of the disease. However, the most common symptoms include:
Chest pain (angina):
this pain, often described as a pressure, tightness, or burning sensation in the chest, can radiate to the left arm, neck, jaw, or back. It can be triggered by physical exertion or emotional stress and is usually relieved by rest or the administration of a vasodilator.
Shortness of breath (dyspnea):
a lack of oxygen in the heart can make breathing difficult, especially during physical exercise.
Fatigue:
feeling tired or weak, even after adequate rest, can be a symptom of ischemic heart disease.
Dizziness or lightheadedness.
Nausea or vomiting.
Cold sweats.
It is important to note that the severity and presentation of symptoms can vary significantly. Some people may experience mild and intermittent symptoms, while others may have more severe and persistent symptoms.
Classification of ischemic heart disease
The buildup of plaque in the coronary arteries can develop gradually over time, often without causing noticeable symptoms until blood flow to the heart is significantly reduced or completely interrupted.
This reduction or interruption of blood flow manifests as symptoms that define ischemic heart disease according to its severity and stability:
Stable angina: chest pain occurs predictably, usually during physical exercise or stress, and is relieved by rest or medication.
Unstable angina: the chest pain is sudden, worsens over time, can occur at rest, and is not relieved by rest or medication. It is a medical emergency that requires immediate attention.
Myocardial infarction (heart attack): it occurs when blood flow to a part of the heart is completely blocked, causing the death of heart tissue. It is a medical emergency that can be fatal.
Causes of ischemic heart disease
The main cause of ischemic heart disease is atherosclerosis, a gradual process in which plaque builds up on the inner walls of the coronary arteries. This plaque is composed of cholesterol, fats, calcium, and other substances. Over time, plaque can harden and narrow the arteries, reducing blood flow to the heart.
There are several risk factors that increase the likelihood of developing ischemic heart disease. Some of these factors are modifiable, while others are not.
Modifiable risk factors:
High blood pressure: it damages arterial walls and facilitates plaque buildup, increasing the risk of blockage. Controlling blood pressure is essential for prevention.
High cholesterol: excess cholesterol in the blood contributes to the formation of plaque in the arteries. Maintaining healthy cholesterol levels is essential.
Diabetes: high blood sugar levels damage blood vessels and increase the likelihood of atherosclerosis. Good diabetes control is essential.
Smoking: smoking damages the arteries, increases blood pressure and reduces the level of oxygen in blood. Quitting smoking is one of the most important measures for prevention.
Obesity: excess weight contributes to other risk factors such as hypertension and diabetes. Maintaining a healthy weight is important for prevention.
Lack of physical activity: physical inactivity increases the risk of obesity, hypertension, and diabetes. Regular exercise strengthens the heart and improves blood circulation.
Unhealthy diet: a diet high in saturated fats and cholesterol contributes to high cholesterol and obesity. A balanced diet is essential for cardiovascular health.
Chronic stress: it can increase blood pressure and contribute to other risk factors. Managing stress effectively is important for heart health.
Non-modifiable risk factors:
Old age: the risk of ischemic heart disease increases with age due to the natural wear and tear of the arteries.
Family history of ischemic heart disease: genetic predisposition increases the likelihood of developing the disease.
Male sex: in general, men have a higher risk of ischemic heart disease than women.
Chronic inflammatory diseases: both rheumatoid arthritis and psoriasis have been shown to increase cardiovascular risk due to their association with coronary atherosclerosis.
Controlling modifiable risk factors can significantly reduce the risk of developing ischemic heart disease.
Complications of ischemic heart disease
Ischemic heart disease can cause various complications, some of which can be very serious. It is essential to seek timely medical attention and follow the doctor’s recommendations to minimize the risk of these complications, which include:
Heart failure: the heart, weakened due to the lack of oxygen, cannot pump enough blood to meet the body’s needs. Heart failure can be a chronic condition that requires ongoing management.
Arrhythmias: irregular heartbeats that can range from mild to life-threatening.
Myocardial infarction (heart attack): this occurs when blood flow to a part of the heart is completely blocked, which can be a major medical emergency.
Sudden cardiac death: in some cases, ischemic heart disease can cause unexpected cardiac death due to a severe arrhythmia.
Diagnosis of ischemic heart disease
The diagnosis of ischemic heart disease involves a complete medical evaluation, which includes a review of the patient’s medical history, a physical examination, and various diagnostic tests. Some of the most common tests include:
Electrocardiogram (ECG): this test records the electrical activity of the heart using electrodes placed on the chest, arms, and legs. An ECG can detect abnormal heart rhythms (arrhythmias), damage to the heart muscle due to a previous heart attack, and signs of ischemia. It is a quick, painless, and non-invasive test.
Stress test: this test evaluates the heart’s response to physical exertion. It is carried out while the patient walks on a treadmill or pedals on a stationary bike while their ECG and blood pressure are monitored. The stress test can reveal signs of ischemia, such as changes in the ECG or chest pain. It can also help determine the severity of coronary artery disease.
Echocardiogram: this test uses sound waves to create images of the heart. A small device called a transducer is placed on the chest and sends out sound waves that bounce off the heart. Sound waves are converted into images that show the structure and function of the heart, including the size of the heart chambers, the thickness of the walls, the movement of the heart valves, and blood flow. An echocardiogram can detect areas of the heart that do not receive enough blood due to blockages in the coronary arteries. There are different types of echocardiograms, such as the transthoracic echocardiogram (TTE), which is performed through the chest, and the transesophageal echocardiogram (TEE), in which a small transducer is inserted through the esophagus to obtain more detailed images of the heart.
Cardiac catheterization (coronary angiography): it is an invasive procedure that allows direct visualization of the coronary arteries. A thin catheter is inserted into an artery, usually in the groin or wrist, and guided to the heart. A contrast agent is injected into the coronary arteries and X-ray images are taken to visualize blood flow. Coronary angiography can detect blockages in the coronary arteries and determine their severity. It can also be used to perform procedures such as angioplasty and stent placement. HM Hospitales has several hemodynamics laboratories where anatomical and functional studies of the heart are performed by inserting thin catheters through the arteries and veins in the groin or arm.https://www.hmhospitales.com/especialidad/hematologia-y-hemoterapia/
Blood tests: blood tests can provide information about risk factors for ischemic heart disease, such as cholesterol, triglyceride, and blood glucose levels. Tests can also be performed to assess kidney and liver function, which can be affected by heart disease.
Myocardial scintigraphy: this nuclear medicine test uses a radioactive tracer that is injected into a vein. The tracer accumulates in the heart muscle and is detected using a special camera. Myocardial scintigraphy can detect areas of the heart that do not receive enough blood due to blockages in the coronary arteries. It can be performed at rest or during physical exertion to compare blood flow under different conditions.
Coronary computed tomography (coronary CT scan): this non-invasive imaging test uses X-rays to create detailed images of the coronary arteries. A contrast agent is injected into a vein and images are taken while the patient is inside a CT scanner. Coronary CT angiography can detect the presence and extent of plaque in the coronary arteries. It is a less invasive alternative to cardiac catheterization.
Cardiac magnetic resonance imaging (MRI): this non-invasive imaging test uses magnetic fields and radio waves to create detailed images of the heart. A cardiac MRI can provide information about the structure and function of the heart, as well as about blood flow. It can be useful for assessing damage to the heart muscle after a heart attack and for detecting other heart conditions.
Treatment for ischemic heart disease is individualized according to the needs of each patient. The goal of treatment is to relieve symptoms, improve blood flow to the heart, reduce the risk of future cardiac events, and improve quality of life. Treatment options include:
Lifestyle changes: adopting a healthy lifestyle is essential for managing ischemic heart disease; this includes a balanced diet, regular exercise, maintaining a healthy weight, quitting smoking, and managing stress. In this context, cardiac rehabilitation has been shown to increase survival after a coronary event by decreasing the probability of new events during follow-up.
Medications: various medications are used to control risk factors and treat ischemic heart disease. These medications may include nitrates to relieve chest pain by dilating the coronary arteries; beta-blockers to reduce heart rate and blood pressure, decreasing the workload of the heart; ACE inhibitors to relax blood vessels and reduce blood pressure, improving blood flow; statins to reduce LDL (“bad”) cholesterol levels in the blood, preventing plaque formation; and antiplatelet drugs to prevent the formation of blood clots that could block the coronary arteries.
Percutaneous coronary interventions (PCI – angioplasty and stent placement): these minimally invasive procedures are used to open blocked coronary arteries. During a PCI, a thin catheter is inserted into an artery, usually in the groin or wrist, and guided to the blockage. A small balloon at the end of the catheter is inflated to open the artery, and often a stent (a small metal mesh tube) is placed to keep it open. PCIs are effective in relieving the symptoms of angina and improving blood flow to the heart.
Coronary artery bypass surgery (revascularization): in cases of severe or multiple blockages in the coronary arteries, coronary artery bypass surgery may be necessary. During this procedure, a blood vessel from another part of the body, such as the leg or chest, is used to create a new pathway for blood to reach the heart, bypassing the blockage. Coronary artery bypass surgery can significantly improve blood flow to the heart and relieve symptoms.
Heart transplant: in very serious cases of ischemic heart disease, when other treatments have not been effective and the heart is severely damaged, a heart transplant may be an option. This procedure involves replacing the diseased heart with a healthy donor heart. Heart transplantation is major surgery with a long recovery period and requires lifelong immunosuppressants to prevent organ rejection. At HM Hospitales, we have a specialized team in heart transplants that offers comprehensive and personalized care. https://www.hmhospitales.com/especialidad/cirugia-vascular-angiologia/
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have any signs of ischemic heart disease, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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