What is ischemic heart disease?
Ischemic heart disease is a disease caused by atherosclerosis of the coronary arteries. Coronary atherosclerosis is a slow process in which collagen formation and accumulation of lipids (fats) and inflammatory cells (lymphocytes) occur. These processes cause narrowing (stenosis) of the coronary arteries.
The process begins during the first decades of life, although no symptoms are shown until coronary artery stenosis worsens, generating an imbalance between oxygen supply to the myocardium and its needs. At this point, stable angina pectoris or sudden occlusion due to thrombosis of the artery occurs, causing a lack of oxygenation of the myocardium, which leads to acute coronary syndrome (unstable angina and acute myocardial infarction).
What are the causes of ischemic heart disease?
It is possible to prevent ischemic heart disease if the cardiovascular risk factors are known and controlled. Some of these factors may be:
- Advanced age.
- More frequent in men, although after menopause it becomes more common in women.
- Family history of premature ischemic heart disease.
- Increase in total cholesterol levels, especially LDL (bad) cholesterol.
- Decrease in HDL (good) cholesterol values.
- Smoking
- High blood pressure
- Diabetes mellitus
- Obesity
- Sedentary lifestyle
- Having previously presented the disease
Types of ischemic heart disease
- Acute myocardial infarction
This is a serious disease that occurs as a consequence of the obstruction of a coronary artery by a thrombus. The final consequence of this obstruction is death (necrosis) of the territory that irrigates the obstructed artery. Therefore, the importance of myocardial infarction will depend on the amount of cardiac muscle lost.
Infarction is usually an unexpected event that can occur in healthy people, although in general it is more common in those with risk factors or in patients who have already suffered other manifestations of ischemic heart disease. The infarction is manifested by chest pain similar to angina, but sustained for more than 20 minutes. It may be accompanied by cold sweat, dizziness, fatigue or anguish. It may occur at rest and does not subside spontaneously.
It is vital that the person with a heart attack gets to the hospital as soon as possible. Ideally, the patient should receive care within the first hour after the onset of symptoms. If this is not possible, treatments such as thrombolysis or angioplasty should be applied during the hours following the infarction. Occasionally, urgent cardiac surgery may even be required.
- Stable angina pectoris
Stable angina pectoris is a symptom of chest pain due to myocardial ischemia that usually lasts between 1 and 15 minutes. Patients describe it as a feeling of tightness, burning, tightness or swelling. Although localized in the sternal area, it may radiate to the jaw, throat, shoulder, back, and left wrist or arm.
Angina pain occurs after physical exercise or strong emotions and is relieved within minutes with rest or sublingual nitroglycerin. It is usually worse in patients with anemia, uncontrolled hypertension and fever. In addition, cold, humidity, smoking or a heavy meal can increase its intensity and frequency.
Diagnosis of the pathology is basically based on clinical suspicion of chest pain, although other complementary tests are not ruled out in the case of atypical symptoms. Patients also usually undergo an electrocardiogram.
The prognosis can be highly variable, depending on the extent and damage to the heart muscle. The factors that have the greatest impact on prognosis are good or poor control of coronary risk factors.
Patients with angina pectoris should rigorously control cardiovascular risk factors and have regular follow-up. Smoking, diabetes, hypertension, cholesterol, etc. should be controlled.
- Unstable angina pectoris
It is usually a sign of very high risk of acute myocardial infarction or sudden death. Unstable angina occurs in the same way as infarction, but without complete occlusion of the coronary artery by the thrombus and without the death of cardiac cells.
It is manifested at rest by pain or tightness that begins in the center of the chest and may spread to the arms, jaw, neck and back. In other words, the symptoms are the same as those of a heart attack, although generally of shorter duration and intensity. This angina should be treated as an emergency, since there is a high risk of infarction, serious arrhythmia or sudden death.