Ischemic heart disease is one of the most frequent pathologies at the cardiological level nowadays. It includes all those patients in whom there is a transient or permanent compromise in the blood flow of any of their coronary arteries (which are responsible for irrigating the heart muscle), either in their more proximal or more distal segments.
Are there types of ischemic heart disease?
Ischemic heart disease is divided into two main groups:
- Stable ischemic heart disease: this encompasses those patients in whom stenosis of one of the coronary arteries occurs progressively, allowing the heart to adapt to this situation of lack of blood supply in some of its territories to avoid suffering irreversible damage.
- Unstable ischemic heart disease: includes those patients in whom, abruptly, generally after rupture of an atheroma plaque, thrombus formation occurs within the artery and acute compromise of the artery flow in a territory that is not “accustomed” to this situation. Depending on whether or not there is complete closure of the artery, and whether or not there is death of part of the heart muscle cells, there are two subgroups:
- Unstable Angina: the acute stenosis formed allows the passage of a minimal amount of blood that prevents the cardiac cells in that territory from dying.
- Acute Myocardial Infarction: due to incomplete or complete closure of the artery, the myocardial cells in that territory stop receiving oxygen and nutrients and therefore die, releasing into the bloodstream a series of markers that allow us to make the diagnosis of myocardial infarction.
How is it diagnosed?
The initial diagnosis is clinical, based mainly on the patient’s symptoms and the electrocardiogram. Subsequently, the diagnosis is confirmed by noninvasive and/or invasive tests.
In stable ischemic heart disease, the typical symptoms are the appearance of central thoracic pain with oppressive characteristics, which generally appears when some type of effort is made, radiating to the neck, jaw or arm (generally the left), and which disappears with rest in about five to ten minutes. These symptoms are also usually stable in terms of the amount of exercise required for their onset, and last for more than a month.
In unstable ischemic heart disease, the onset of pain is usually abrupt, of great intensity, associated with general malaise, profuse sweating and nausea, of greater or lesser duration depending on the type. Sometimes, it presents as rapidly progressive angina with episodes of pain that progress in intensity and appear with less exertion until they occur at rest.
The electrocardiogram is a fundamental weapon in this pathology, since it not only helps us in the diagnosis, but also allows us to stratify the severity of the patient and the emergent need or not to perform an invasive approach to solve the coronary problem presented.
Why does ischemic heart disease occur?
The most frequent etiology is the intracoronary formation of atheromatous plaques that either abruptly or progressively compromise coronary flow. Atherosclerosis is a pathology that, although it has a genetic component, is closely related to the control of cardiovascular risk factors. These are the following: arterial hypertension, diabetes mellitus, hypercholesterolemia, smoking.
In turn, there are a series of lifestyle habits that either directly or indirectly favor the appearance of the aforementioned cardiovascular risk factors, such as obesity, sedentary lifestyles, inadequate eating habits, stress, etc.
Avoiding the appearance of these factors and, if they do appear, controlling them strictly is fundamental to avoid the appearance of atherosclerosis and, secondarily, ischemic heart disease.
Symptoms of ischemic heart disease
The fundamental symptom is chest pain, which we have detailed above. Sometimes, especially in the elderly and diabetics, the symptoms may not be as florid and intense, and may be confused with banal pathologies. It is not uncommon that in this type of population the symptom is exertional dyspnea, i.e., noticing “shortness of breath” when exerting oneself. This is what we call “anginal equivalent”.
On other occasions, especially when the cardiac territory with flow deficit is the lower territory, the symptom may be epigastralgia, that is, pain located in the upper abdomen, just below the sternum. Therefore, it is essential that, when chest pain, dyspnea or choking, or epigastric discomfort appear, a specialist should be consulted for a correct diagnosis.
How is ischemic heart disease treated?
In unstable ischemic heart disease, the treatment of choice is coronary revascularization, which can be performed in two ways:
- Percutaneous: by performing a cardiac catheterization where, through an artery, the heart is accessed, the coronary stenosis is confirmed and resolved by implanting a coronary stent, which is nothing more than a metallic scaffold that resolves the coronary artery stenosis.
This technique has nowadays evolved a lot and is considered the technique of choice given the low rate of complications (partly related to the appearance of the approach through the radial artery, which is an artery of very small caliber whose complications are scarce and of low severity), the possibility of being performed under local anesthesia, and the technological advance of stents, which allow us to obtain excellent results both in the short and long term.
- Surgical: By placing veins or arteries that go from the aorta to the segment of the coronary artery distal to where the stenosis was located, in order to skip that point and return blood to the more distal territories of the artery. This technique continues to play an important role in patients in whom coronary stent implantation is not possible or is considered inadequate due to the coronary anatomy or the presence of pathology in multiple coronary arteries.
In stable ischemic heart disease there are two types of treatment:
- Invasive treatment: described above, either by catheterization or surgery. It has the advantage of a rapid improvement in the patient’s symptoms.
- Medical treatment: By means of drugs that reduce the oxygen demands of the cardiac muscle, sometimes improving or even eliminating symptoms.
In general, the choice of treatment will depend on the patient’s initial symptoms, age and the severity of coronary ischemia observed in noninvasive tests such as ergometry, stress echocardiography, or coronary anatomical assessment by AngioCT.
For more information, please consult a Cardiology specialist.