Ischemic Heart Disease - Causes, Symptoms & Treatment

Ischemic heart disease, also known as coronary artery disease, is a condition that affects the blood flow to the heart muscle. It occurs when plaque buildup in the arteries narrows them and restricts the flow of oxygen-rich blood to the heart. 

Indians are more prone to cardiovascular diseases (CVDs) like Ischemic Heart Disease at a younger age. This article aims to provide an overview of ischemic heart disease pathophysiology, its causes, symptoms, and available treatment methods. 

Ischemic heart disease is when the heart is starved of oxygen due to a reduced blood flow through coronary arteries, which are the blood vessels that supply blood to the heart muscle.Individuals with less than 50% restriction in blood flow usually do not experience any symptoms.

However, chest pain and shortness of breath appear as ischemic heart disease progresses. A heart attack may also occur if the major coronary arteries get completely occluded and the heart muscle cells start dying because of a severe lack of blood supply.

Types of Ischemic Heart Disease

Based on the acute and chronic forms, there are two types of ischemic heart diseases:

1. Stable ischemic heart disease: This is the chronic form of the disease in which fatty deposits accumulate in the inner wall of the arteries gradually over the years, narrowing it down and obstructing the blood flow to the heart. 

2. Acute coronary syndrome: This sudden form of the disease can be life-threatening. Acute coronary syndrome results when the plaque in the coronary artery ruptures and forms a blood clot that completely obstructs the vessel. This causes complete cessation of blood supply to the heart muscle, resulting in the death of cells and myocardial infarction (heart attack).  

Ischemic heart disease progresses very slowly. It may take years for the plaque to obstruct the blood flow significantly enough to cause observable symptoms. It is very common to have “silent ischemia”, but the patients do not experience any pain. 

Symptoms develop when the heart has to pump harder to supply blood to the body.The symptoms of ischemic heart disease include:

1. Chest Pain: It usually occurs with physical or emotional stress and goes away with rest or medicine. Chest discomfort may be associated with tightness, a squeezing sensation in the chest, heaviness, shortness of breath, or nausea.  

2. Chest tightness: The feeling of a heavy weight on the chest is a common symptom.

3. Shortness of breath: Most commonly with exertion, though can also occur with normal physical activities in severe cases.

4. Nausea: It can often be misinterpreted as indigestion. Medical attention is needed if the patient has other accompanying symptoms that indicate a heart problem.

It should be noted that a heart attack may be the first indication of ischemic heart disease in a patient who has not been diagnosed with it before. Thus, families and patients must be aware of heart attack symptoms to get timely medical intervention. 

Ischemic heart disease is caused by hardening and thickening of the blood vessels. It is due to plaque deposition. Plaque comprises cholesterol, calcium, waste products, and fibrin. It starts depositing on the inner walls of the coronary arteries. The causes of IHD are:

1. High Blood Pressure: Chronic high blood pressure (hypertension) can damage the inner walls of the coronary arteries, making them more susceptible to plaque buildup.

2. High Cholesterol: Elevated LDL (bad) cholesterol levels in the blood can contribute to plaque formation in the coronary arteries.

3. Atherosclerosis: The primary cause of ischemic heart disease is the buildup of fatty deposits (plaques) inside the coronary arteries. These plaques narrow the arteries, reducing blood flow to the heart muscle.

4. Coronary Artery Spasms: Temporary spasms or constrictions of the coronary arteries can reduce blood flow to the heart, leading to chest pain or angina.

5. Blood Clots: The formation of blood clots within the coronary arteries can block blood flow, causing a heart attack. Clots often develop on the surface of ruptured plaques. 

Ischemic Heart Disease Risk Factors 

Lifestyle factors are the most common IHD risk factors. These include:

1. Unhealthy Diet: Diets high in saturated and trans fats and excessive salt and sugar intake can promote atherosclerosis and raise the risk of ischemic heart disease.

2. Lack of Physical Activity: A sedentary lifestyle contributes to weight gain and can lead to obesity and high blood pressure, increasing the risk of heart disease.

3. Smoking: Smoking damages blood vessels, increases blood pressure, and promotes the development of atherosclerosis, all of which raise the risk of ischemic heart disease.

4. Diabetes: Uncontrolled diabetes can damage blood vessels and increase the risk of atherosclerosis. It also affects the body's ability to regulate blood sugar, harming the heart.

5. Obesity: Being overweight or obese can lead to an unhealthy lipid profile, insulin resistance, and an increased risk of developing heart disease.

6. Family History: A family history of heart disease can increase the genetic susceptibility to developing ischemic heart disease.

There are several preventive measures that individuals can take to reduce their risk of developing ischemic heart disease. Adopting a healthy lifestyle and changing daily routines can significantly reduce the risk of developing this condition. 

1. Eat healthy: As fat and cholesterol are the major constituents of atherosclerotic plaque, cutting down on foods high in trans fats and saturated fats, such as fried foods, can significantly reduce the risk of ischemic heart disease.

2. Exercise regularly: Aerobic exercises such as walking, cycling, swimming, yoga, and playing tennis help to keep the heart healthy. An exercise regimen of 150 minutes a week (30 minutes per day for 5 days) is usually recommended, but it is better to consult a physician to know the safe limits.

3. Maintain a healthy weight: Obesity increases the risk of cardiovascular diseases manifold. Know your ideal weight and try to achieve and maintain it through diet and exercise.

4. Quit smoking: Smoking or consuming any other form of tobacco is a major risk factor for heart disease. Giving up an addiction is difficult, so do not hesitate to seek professional help and support.

5. Manage stress: Chronic stress can aggravate heart problems. Learn to manage stress through meditation, yoga, breathing exercises, or mindfulness.

Ischemic heart disease diagnosis is done with the help of a combination of assessments mentioned below. The goal is to determine if there is any blockage or narrowing of the coronary arteries and whether the blood flow to the heart is obstructed.

1. Physical examination: As the first step, the physician will conduct a physical examination that typically includes measuring the blood pressure and listening to the heart rhythm with a stethoscope to determine any irregularity. He will enquire about the symptoms and for how long the patient has been experiencing them and may enquire about the lifestyle of the patient.

2. Medical and family history: The physician will enquire about the medical history of the patient and also if there is any family history of heart disease to help determine the risk factors of the patient for ischemic heart disease.

3. Blood tests: Cholesterol and triglyceride levels and biomarkers such as troponin and CK-MB are measured with the help of blood tests to determine heart damage and the severity of atherosclerosis. 

4. Echocardiography: Sound waves are used to help locate any abnormalities in the structure or function of the heart.

5. Stress tests:  These are the diagnostic tests in which stress is induced either physically or chemically, and then how the heart functions during stress is studied. Exercise stress tests and nuclear stress tests are examples of cardiac stress tests.

6. Electrocardiogram (ECG/EKG): This test records the electrical activity of the heart and can detect irregularity in heart rhythm, current or old heart attacks, and ischemia.

7. CT angiography: This is a non-invasive imaging technique in which CT (computed tomography) is used to create detailed images of the coronary arteries, and the extent and location of blockages can be easily determined.

8. MRI: This imaging technique provides detailed information about the structure and function of the heart and helps diagnose abnormalities, including IHD.

9. Coronary calcium score: Measures the amount of calcium deposition on the walls of the coronary arteries and helps grade the risk of atherosclerosis and ischemic heart disease.

10. Cardiac catheterisation: This is an invasive procedure used for ischemic heart disease diagnosis. In this procedure, a catheter (a thin, flexible tube) is inserted into a blood vessel and threaded up into the coronary arteries. A contrast dye is then injected and X-ray images are taken to detect any blockages in the coronary arteries.

Please note that tests advised or prescribed might vary from patient to patient.

How to Prepare for the Doctor’s Consultation?

If a person is planning to visit a doctor for consultation regarding ischemic heart disease symptoms, the following should be considered to get the most out of the visit:

1. Take a prior appointment to prevent long waiting times.

2. Take the patient's medical file so that the doctor knows about the comorbidities and the medicines that the patient is already on.

3. The patient should be honest with the doctor about his/her lifestyle, including alcohol and tobacco consumption.

4. Be prepared for a physical examination where the doctor may check blood pressure and listen to the heart with a stethoscope.

5. Based on symptoms and history, the doctor may suggest diagnostic tests and investigations to confirm the diagnosis.

6. The patient should ask the doctor about risk factors, the symptoms to look out for, how to prevent the progression of the disease and information about the medicines prescribed. 

7. If surgery is recommended, the patient should ask about the risks involved, expected outcomes, recovery time, expenses involved, etc.

Treatment of ischemic heart disease involves a multifaceted approach, including lifestyle modifications, medications, and surgery in some cases. It is important to consult a doctor for a personalised treatment approach.

Home Remedies  

Although home remedies are not treatment for ischemic heart disease, they are beneficial to some extent in preventing this condition. It is important to understand that home remedies should only be taken as a complement to the medical treatment advised by the doctor.

1. Switch to a heart-healthy diet rich in whole grains, fruits, vegetables, and lean proteins. Avoid saturated fats, trans fats, and processed foods.

2. Include foods rich in omega-3 fatty acids, such as walnuts, flaxseed, and fatty fish, as they help reduce inflammation and help keep the heart and blood vessels healthy.

3. Exercise regularly. Aim for 150 minutes of moderate-intensity exercise per week, as recommended by the American Heart Association (AHA).

4. Manage stress by meditation, yoga, or indulging in any activities that you enjoy.

Ayurvedic Treatment

The first step in dealing with high blood pressure is to avoid things that can cause it. Ayurveda, a traditional health system, focuses on preventing high blood pressure and staying healthy. Instead of using medicines, Ayurveda suggests eating the right foods and making lifestyle changes to control high blood pressure. Some natural remedies mentioned in Ayurveda are:

1. Bhringraja: This herb can help control high blood pressure. Mix two teaspoons of bhringraj leaf juice with one teaspoon of honey and take it twice daily to keep your blood pressure normal.

2. Brahmi: It has been found to lower blood pressure when taken by mouth.

3. Sarpagandha: Rauwolfia Serpentina, also known as Sarpagandha, is very helpful for managing high blood pressure. Using powdered roots can help reduce blood pressure.

Surgery

Surgery may be required in cases of ischemic heart disease where lifestyle modifications and medicines cannot manage the condition. The two most common surgical interventions used for treatment of IHD are:

1. Coronary angioplasty: This is a minimally invasive procedure in which the blocked coronary arteries are reopened using a catheter with a balloon. A stent may also be placed inside the artery to help it stay open.

2. Coronary Artery Bypass Graft: This procedure involves bypassing the blocked portion of the coronary arteries with blood vessels taken from elsewhere in the body. This restores blood flow to the heart. The treatment plan and selection of procedures depend upon the patient’s specific health condition and the opinion of the physician. 

Cost of Ischemic Heart Disease Treatment

Treatment of ischemic heart disease using medicines may cost around ₹1500 to ₹2000 per month. Medications are often enough to manage ischemic heart disease; however, surgery might be required in the more severe cases.

Prognosis and Survival Rate for Ischemic Heart Disease

The prognosis for individuals with ischemic heart disease varies based on several factors such as age, medical and family history, symptoms, and risk factors. With timely diagnosis, appropriate treatment, and healthy lifestyle modifications, the progression of ischemic heart disease can be slowed down significantly, and the patients can live a long and productive life.

Disclaimer: The prognosis and survival rate of ischemic heart disease varies from person to person.

Failure to timely diagnosis and inadequate management of ischemic heart disease can lead to serious complications in the long run (5). The most common ones include:

1. Heart attack: Myocardial ischemia (heart attack) occurs when a major coronary artery gets completely blocked, and a part of the heart muscle dies due to lack of blood supply. This condition can be fatal and requires emergency medical intervention.

2. Irregular heart rhythm (arrhythmia): When the heart muscle does not get adequate oxygen and nutrients, it adversely affects its function. The heart rate becomes too fast or too slow, disturbs the normal heart rhythm. This can cause tiredness and dizziness or even result in blood clot formation that can cause stroke if it travels to the brain.

3. Heart failure: Ischemic heart disease may lead to heart failure. Depending upon the portion of the heart affected, symptoms vary. Right-sided heart failure results in fluid build-up and causes leg, abdomen, or liver oedema. Left-sided heart failure can cause shortness of breath with exertion, palpitations, chest pain, etc.

When to Consult a Doctor?

People often confuse the symptoms of myocardial ischemia with indigestion and do not consult a doctor. Seek immediate medical attention for any of the below-mentioned symptoms:

1. Chest pain, particularly left-sided or in the centre of the chest, persists or comes and goes away

2. Tightness in the chest, squeezing sensation or chest heaviness

3. Shortness of breath with or without chest pain or discomfort

4. Cold sweat

5. Nausea 

6. Lightheadedness or dizziness

The recommended diet for ischemic heart disease focuses on lowering the risk factors and improving heart health. Consulting a certified dietitian is always a good idea for an individualised diet plan. 

1. Fruits and Vegetables: Aim for at least five servings of fruits and vegetables daily. They are rich in vitamins, minerals, and fibre, which are heart-healthy.

2. Whole Grains: Choose whole grains like whole wheat, oats, brown rice, and quinoa over refined grains like white bread. They contain more nutrients and fibre.

3. Lean Proteins: Opt for lean protein sources such as skinless poultry, fish, beans, and legumes. Protein is an excellent source to build muscle, including heart muscle. Limit red meat intake. 

4. Healthy Fats: Include sources of healthy fats like olive oil, nuts, seeds, and avocados. These fats can help improve cholesterol levels.

Ischemic heart disease is among the most significant health concerns in India and worldwide. While this can be a life-threatening condition, it can be prevented.

Join the HexaHealth community and take control of your cardiac health. We have you covered whether you are looking for the best doctors in your city, need expert advice, or information on medical conditions. Empower yourself with personalised healthcare and tread on a path of a healthy, happy life!

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