Ischemic heart disease

What is it

Ischemic heart disease is a pathological condition of the heart that appears when there is an insufficient supply of blood and oxygen to the heart muscle.The adjective “ischemic” means that an organ, the heart in this case, does not receive enough blood and oxygen, thus causing suffering of the affected tissue.

Ischemic cardiomyopathy is in fact the most common heart disease and affects about 1 in 100 people, often middle-aged men.

Causes

Myocardial ischemia is generally due to the presence of partially obstructed or stiffened and narrowed coronary arteries (stenosis). The most frequent cause of ischemic heart disease is atherosclerotic disease.In atherosclerosis, lipids (mainly cholesterol) and other substances are deposited on the inner wall of the arteries forming plaques that reduce the elasticity of the vessel walls and, depending on the volume, lead to a progressive narrowing of the vascular lumen until it is completely occluded.

The resulting ischemia can also cause the appearance of arrhythmias following the alteration of electrical conduction of the heart, compromising its functionality in the long run.

The plaque also reduces the integrity of the endothelial cells present on the inner surface of the vessels favoring the formation of thrombi, which not only also contribute to the occlusion of the vessel but can also detach going to obstruct vessels of smaller caliber.

Among the frequent causes of ischemic heart disease we also find coronary heart diseases, also called coronary artery disease, chronic such as chronic stable or exertional angina and acute such as unstable angina, heart failure or silent ischemia. In the first case it is a condition that does not change significantly over time and appears following intense physical exercise while the unstable form can arise even at rest.

Finally, several predisposing factors such as hypercholesterolemia, high-fat diet, arterial hypertension, diabetes, stress, obesity, sedentary lifestyle, smoking, familiarity and genetic predisposition must also be considered.

Most common symptoms

Acute coronary syndrome is a definition that brings together all the clinical manifestations of ischemic cardiomyopathy.In the most typical cases, ischemic cardiomyopathy presents with chest pain under the sternum (angina pectoris or anginal pain) and a sense of pressure in the chest.

The pain can spread to the left arm and sometimes to the throat with a feeling of choking or to the mouth of the stomach confusing with the symptoms of common indigestion and inducing nausea or vomiting. It is perceived as a compression, narrowing or crushing that finds relief with rest.

Other typical symptoms of ischemic heart disease that accompany the classic pain are:

• intense sweating
• shortness of breath especially during activity but also in a lying position,
• fatigue
• loss of consciousness
• Palpitations
• cough
• general swelling.

The symptoms typically last less than 20 minutes, can be triggered by physical activity and resolve with its interruption. Even a strong emotion or intense anger can trigger the symptomatology.

The spraying deficit can involve a more or less extensive area and can be a transient or permanent ischemic attack: in this case the most serious damage occurs.

Complications

The consequences of cardiac ischemia depend on several factors:

• the duration of occlusion
• the extent of the area of cardiac tissue supplied by the occluded vessel
• the possibility of formation of a “collateral circle” of nearby vessels that could guarantee their survival even when a main vessel is occluded.

The longer the lack of oxygenation to the tissue, the greater the damage to the tissue itself. It then passes from a transient and reversible ischemia (angina) to tissue death (necrosis or heart attack).

The larger the area involved, the more severe the ischemia and heart attack will be.

Being serious, the daily life of patients suffering from this disease must be commensurate with their physical state in order to reduce the risk of developing subsequent complications such as heart failure, arrhythmias, sometimes causes of mortality, and cardiogenic shock.

Prevention

We speak in general of prevention when we aim to implement all those useful measures to avoid the appearance of disorders or pathologies in healthy subjects and, in this case, the best method is to avoid heart and cardiovascular diseases.Since atherosclerosis is the main cause of ischemic heart disease, the latter can be prevented by modifying risk factors whenever possible.

It is therefore important to follow a healthy lifestyle and in particular:

• smoking abstention
• practice regular exercise
• Follow a balanced diet with particular attention to reducing fat intake and, above all, cholesterol, favoring whole grains, fruits and vegetables, reducing alcohol intake, maintaining a healthy weight and normal cholesterol levels.

Arterial hypertension and diabetes are also risk factors for the onset of ischemic heart disease and, therefore, must be kept under control also for this.

Atherosclerotic disease begins at a young age and progresses with age. It is therefore necessary not only to intervene early by assuming lifestyle habits that protect over the years, but also to extend correct and conscious behavior to all members of the family.

With a view to prevention for ischemic heart disease, as well as a change in behavior, it is sometimes necessary to combine a pharmacological intervention, in particular for high-risk subjects.

Among the most prescribed drugs in this phase we find low-dose acetylsalicylic acid and antiplatelet agents to keep the blood well fluidized and reduce the possibility of clot formation and, subsequently, thrombosis. Also beta-blockers and ACE inhibitors are widely used especially to control blood pressure levels also normalizing the heart rate.

Treatment

To mark a therapeutic scheme it is first of all essential to make a correct diagnosis.Generally we start from a physical evaluation that may be normal or show clear signs of water retention (swelling in the legs, enlarged liver, abnormal noises in the lungs during breathing, altered heartbeat, high pressure of the neck vein that manifests itself with the clearly visible pulsating character), a sign of impaired circulation. This first phase of overall control is associated with more specific tests.

The most used instrumental examinations today are:

• electrocardiogram to record the electrical activity of the heart and highlight any arrhythmias or other abnormalities
• myocardial scintigraphy performed on a stationary bike or treadmill to evaluate exercise ischemia
• coronary angiography or coronary angiography to have a structural view of the coronary arteries through the use of a contrast agent.

The treatments depend on the clinical manifestation of heart disease but have as a common goal to restore the coronary flow directed to the heart.

If ischemic heart disease has already occurred instead of preventive drugs suitable for subjects at risk (acetylsalicylic acid, beta blockers, etc.) A different and more “aggressive” therapeutic scheme is adopted with the aim of controlling the progression of the disease and avoiding the appearance of new events as much as possible.

In these cases, standard drug therapy involves the use of calcium channel blockers, beta-blockers and / or antiplatelet agents at higher doses or nitroderivatives depending on the opinion of the doctor who, in formulating the prescription, will evaluate the intensity of the disorder, the presence of any other diseases and the individual response to treatment.

In any case, these are drugs that must be taken regularly, every day, and that do not cure the disease, but prevent its manifestations.

If therapy fails to control ischemia, revascularization surgery through coronary angioplasty or placement of a coronary artery bypass should be considered. In the first case, a balloon is inserted inside the lumen of the coronary vessel usually associated with a metal mesh called “stent”.

The balloon is then inflated at the narrowing present in the artery, improving blood flow to the extremities of the body and, sometimes, also eliminating symptoms and ischemia.

The bypass operation instead involves the arrangement of both venous and arterial ducts able to create an alternative way to pass the blood flow thus putting in communication the portion before and after the stenosis.

When to consult your doctor

If there are worsening of the general physical state, the feeling of having more difficulty in carrying out daily activities and any other disorders that may add to the underlying disease is always good to report it to the doctor.For the most specific cardiac symptoms and for all problems related to the use or effect of angina drugs, reference should always be made to the cardiologist.

If anginal symptoms do not disappear within twenty minutes or worse, myocardial infarction may be present.

Myocardial infarction is a cardiological emergency that requires the fastest possible intervention and, therefore, you should call 118 directly and immediately contact a cardiology emergency center.

However, considering the wide spread of atherosclerosis or in general of coronary or cardiac diseases predisposing to real ischemic cardiomyopathy, it is important that in particular the family doctor periodically monitors his patients, especially those at high personal risk or with familiarity for this pathology.

The beginning of a drug therapy, even in a preventive regime, should however be carefully evaluated according to the real needs as it is not without side effects. On the other hand, the adoption of a correct lifestyle is to be recommended on a wide range.