Understanding the Types of Ischaemic Heart Disease

Ischaemic heart disease (IHD) is characterised by recurring chest pain or discomfort caused by a lack of blood supply to a portion of the heart muscle. "Ischaemic" refers to a body part that does not receive adequate blood flow and oxygen.

It is important to understand that heart problems, such as chest pain (angina), can occur in people with IHD as well as those with other heart conditions. Some people may experience silent ischaemia, which occurs when the heart lacks oxygen without causing pain. Therefore, early detection and management of these issues is critical for a healthy heart.

Additionally, there are various types of ischaemic heart disease, each with its distinct characteristics and implications for cardiovascular health.

Understanding various types of ischaemic heart disease helps recognize distinct clinical presentations and management approaches for those affected. The doctors can deliver more personalized and effective care to those with IHD. Now, let's look at the various types of chronic ischaemic heart disease, their symptoms, and their reason for occurrence.

1. Obstructive Coronary Artery Disease

Obstructive coronary artery disease (CAD) is a common cardiovascular disease marked by significant blockages or narrowing of the arteries. These arteries supply oxygenated blood to the heart muscle. It occurs when more than 50% of the artery is blocked.

Symptoms

The progression of obstructive CAD often occurs gradually. You might not experience noticeable symptoms until the condition becomes severe. Keeping that in mind, these types of chronic ischaemic heart disease include the following symptoms: 

1. Weakness

2. Fatigue

3. Lightheadedness or dizziness

4. Breathing difficulty

5. Intense pain, pressure, or tightness in the chest

6. Discomfort in one or both arms, jaw, or neck

Causes

Obstructive CAD is primarily caused by atherosclerosis, a condition characterized by plaque buildup within the arteries. It narrows the inner diameter of the arteries, leading to stenosis. 

This restricts blood flow through these arteries. Contributing factors to atherosclerosis, which leads to plaque accumulation, include but are not limited to:

1. High cholesterol levels

2. High blood pressure

3. Smoking

4. Diabetes

5. Obesity

6. Sedentary lifestyle

2. Non-obstructive Coronary Artery Disease

Nonobstructive coronary artery disease refers to cholesterol deposits that typically don't block blood flow or cause angina. Diagnosing this condition can be difficult as imaging tests may not reveal the usual plaque buildup.

Symptoms

Non-obstructive CAD can manifest with symptoms unlike those of obstructive CAD. Their symptoms include but are not limited to:

1. Angina (chest discomfort or pain, often triggered by exertion or stress, indicating insufficient blood flow to the heart muscle)

2. Persistent tiredness and energy levels

3. Heart palpitations

4. Lightheadedness

5. Pain in arms, back, jaw, or neck

 Causes

These types of ischaemic heart disease appear to be closely associated with prevalent risk factors for heart disease. These risk factors contribute to coronary microvascular dysfunction, potentially resulting in endothelial damage to the inner lining of the coronary arteries. The exact cause of coronary vasospasm (abnormal and excessive constriction of heart arteries) remains unclear. Common causes you can look out for are:

1. Excess weight or obesity

2. Diabetes

3. High blood pressure

4. Elevated cholesterol levels

5. Smoking

3. Spontaneous Coronary Artery Dissection (SCAD)

Spontaneous coronary artery dissection (SCAD) represents an urgent cardiac condition marked by the formation of a tear within a heart artery wall. This tear can impede or completely obstruct blood flow to the heart. This potentially leads to a heart attack, irregular heart rhythms, or could be fatal.

Symptoms

Similar to the other types of ischaemic heart disease, the symptoms for this dissection are the same. The symptoms can include:

1. Chest Pain or Pressure

2. Pain in Arms, Shoulders, Back, or Jaw

3. Unusual Sweating

4. Upset Stomach

5. Rapid Heartbeat or Flutter Sensation in the Chest

6. Dizziness

Causes

The precise cause of spontaneous coronary artery dissection remains unknown. However, certain risk factors have been associated with an increased likelihood of experiencing SCAD:

1. SCAD predominantly affects women, particularly those in their 40s and 50s, though it can occur in men as well.

2. Some instances of SCAD have been observed in women shortly after giving birth, potentially linked to hormonal changes and increased stress on blood vessels during pregnancy or postpartum.

3. SCAD may occur following instances of extreme physical exertion or severe emotional distress.

4. Genetic conditions affecting connective tissue can predispose people to SCAD as well.

5. High blood pressure has been associated with an increased likelihood of experiencing SCAD.

6. Illegal drug use is another factor that may contribute to the occurrence of SCAD.

Treatment for ischaemic heart disease aims to manage symptoms, reduce the risk of complications, and improve overall heart health. The treatment for various types of ischaemic heart diseases includes: 

1. Medications: This is the primary approach in treating the condition. Medicines are often used to manage risk factors and alleviate symptoms associated with coronary artery disease. Your healthcare provider might recommend one or more drugs:

1. Aspirin or clopidogrel to reduce the risk of blood clot formation

2. Beta-blockers to lower heart rate and blood pressure

3. ACE inhibitors or angiotensin receptor blockers (ARBs) to manage blood pressure

4. Statins to control cholesterol levels, and nitroglycerin to alleviate chest pain

2. Lifestyle Changes: Modifying your lifestyle can help treat ischaemic heart disease. These changes include:

1. Dietary Changes: Emphasising a heart-healthy diet low in saturated fats, cholesterol, and sodium while high in fruits, vegetables, whole grains, and lean proteins.

2. Regular Exercise: Engaging in physical activity most days of the week to improve cardiovascular health.

3. Quit Smoking: This is crucial in reducing the risk of further artery damage.

4. Stress Management: Stress-reduction techniques or counseling may be recommended as they can impact heart health.

3. Surgery: Some people may need surgical interventions to manage ischaemic heart disease. Depending on your specific case, the doctor may recommend the following: 

1. Coronary Angioplasty and Stenting: A procedure to open narrowed or blocked arteries by inserting a balloon to widen the artery, often followed by placing a stent to keep the artery open.

2. Coronary Artery Bypass Grafting (CABG): Involves using blood vessels from other parts of the body to create detours around blocked coronary arteries, improving blood flow to the heart.

The cost of managing these different types of chronic ischaemic heart disease in India can vary based on: 

1. The severity of the condition

2. Type of treatment required

3. Doctor’s expertise

4. Surgical procedure

The overall price usually includes the cost of diagnostic tests, medications, surgical interventions, and long-term management. Given below is a cost overview for surgical interventions:

Note: These are estimated costs. Please contact your healthcare provider for an accurate price, as the price may vary based on individual cases.

Ischaemic heart disease alters blood flow to the heart, impacting overall health. Recognizing its types, identifying symptoms, and seeking prompt medical attention are needed for effective management. Adopting heart-healthy habits and regular check-ups prevents ischaemic heart disease.

Our team of experts at HexaHealth is dedicated to providing personalized guidance and support to individuals facing or at risk of ischaemic heart disease. We help you understand the nuances of different conditions and offer insights into financial support. Please feel free to contact us.

Suggested Reads

1. Ischemic Heart Disease Causes
2. Heart Failure
3. Coronary Artery Disease