Ischaemic heart disease

Ischaemic heart disease, also known by the term coronary artery disease, is a condition affecting the blood supply to the heart. Blood vessels are obstructed and thinned due to cholesterol plaque deposits on the walls, lessening the nutrients and oxygen supply to heart musculature that are necessary for the heart to work properly. It may lead to sudden deprivation of the blood supply to a part of the heart, which will then result in the loss of heart tissue in that specific location, and eventually, a heart attack.

The pumping of the heart provides oxygenated blood to several essential organs, so any malfunction can instantly have an effect on the oxygen supply to organs such as the kidneys, brain, etc. This will result in the loss of tissues within these distinct parts, as well as failure or even death. Ischaemic Heart Disease is the greatest cause of death in various countries worldwide.

Ischemic heart disease does not develop on its own. There are a number of factors that bring on the illness. Two of these factors include smoking and diabetes mellitus. High cholesterol levels are also present in persons with ischemic heart disease. Individuals with higher levels of blood cholesterol, or hypercholesterolemia, are more prone to develop this illness than are those who do not suffer from this condition. One theory in the formation of ischemic heart disease is the presence of hypertension, as well as genetic and hereditary factors. Gender also plays a role; research shows that males are more prone to acquiring the disease. However, females have no reason to be complacent. Post-menopausal women are found to have the same risk as that of men. Stress is another factor considered by researchers in the development of heart disease. However, there is currently no study that fully verifies this claim.

Ischemic heart disease takes place when plaque is formed in the blood vessels of the heart. The atheromatous plaques create a sort of blockage, causing the vessels to narrow. This narrowing makes it difficult for the blood to flow to and through the heart. The heart fails to receive the proper oxygen and nutrients that are present in the blood. This obstruction and lack of oxygen leads to tissue death, an occurrence known as myocardial infarction or, more popularly, heart attack.

There are many signs and symptoms of ischemic heart disease. One of these is myocardial infarction, a severe type of pain that is often fatal. In many patients, however, the most common warning sign takes the form of angina pectoris. Angina pectoris, popularly known as angina, is a form of chest pain that occurs after heavy or strenuous activity such as exercise. The ache is often relieved by rest, although this is not always the case. Angina pectoris is a kind of pain that begins in the middle part of the chest. The pain then radiates down the left arm, and spreads up to the jaw and back. People who have experienced angina describe the pain as crushing or constricting. It has a common duration of five to twenty minutes. Sweating may also take place during the attack.

The immediate action to relieve the symptoms is to let the patient rest from the activity. When rest periods fail to deliver relief from symptoms, sublingual nitrate medications are given. Aside from angina, there are other signs that can be indicative of ischemic heart disease. One is the occurrence of tendon xanthomas, in which the Achilles tendon thickens or congeals. Arcus lipidus takes place in youth. All of these signs point to hereditary hyperlipidemia. Other things to be noted in the patient are anemia, obesity, diabetes, thyroid problems, and peripheral vascular disease. To help document the electrical activity of the heart, an electrocardiogram or ECG is used. The readings are normal in patients at rest after an angina attack. When there is pain, however, the ST segment is depressed and the T wave is inverted. This is indicative of ischemia.

The opposite takes place in a heart attack. The ST segment becomes elevated, a condition which may change or progress. Another testing measure is the echocardiogram. This presents any abnormality in the heart chambers. This tool is used to assess how effectively the heart is pumping blood to other parts of the body. Among patients who exhibit the signs and symptoms of heart disease yet have normal ECG patterns, an exercise test is utilized. This is called the treadmill test or TMT. This testing measure is for those belonging in the high-risk categories who are ages 35 and above. Another helpful diagnostic tool is myocardial perfusion scanning. This consists of the use of radioactive thallium to measure the level of nutritive delivery of arterial blood to a capillary bed in the biological tissue.

For a more precise result, a coronary angiogram is employed. An angiogram can show the exact location of the stenosis, or narrowing. In addition, it assists in determining the appropriate therapy for the condition.

Nitrates are prophylactic drugs that dilate the coronary artery and prevent pain from occurring. Drugs that belong in this category include Isosorbide Mononitrate and Isosorbide Dinitrate. These drugs are administered sublingually (beneath the tongue) to relieve pain in a few minutes. A Beta Blocker such as Propanolol, a Calcium Channel antagonist, alleviates pain by acting as a vasodilator to lessen the oxygen demand of the myocardium and reduce the excitability and conductivity of the cardiac muscle. It can also lower the blood pressure. These drugs also can be used to lower the cholesterol levels of hypercholesterolemia patients.

When medical treatment fails, surgery is the next step to alleviate pain. If the Angiogram shows that there is significant disease in the blood vessel, Coronary Angioplasty is recommended, wherein an inflated balloon is placed inside the dilated blood vessel. If it is totally blocked, Coronary Artery Bypass Grafting will be done to relieve the blockage.

There has been a growing realization that bypass surgery helps to improve quality of life only by relieving its symptoms, and does not significantly increase life expectancy. Therefore, the benefits of bypass surgery are limited. With proper treatments and techniques such Angioplasty, most patients will be able to lead a normal and healthy life. Diabetic and hypertensive patients are advised to exercise daily, quit smoking, avoid fatty foods, and modify their lifestyles to control their diseases.


Last updated on Mar 1st, 2009 and filed under Cardiovascular Disorders. Both comments and pings are currently closed.

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