The heart muscle, in order to work, needs blood that is supplied by the coronary arteries, which are the blood vessels that irrigate the heart.
Ischemic heart disease is a disease caused by a mismatch between the blood supply through the arteries and the heart’s blood needs. In other words, less blood reaches the heart muscle than it needs to contract effectively.
Ischemic heart disease is usually due to less blood reaching the arteries of the heart than is needed, but it can also be due, more rarely, to the heart occasionally needing more blood than usual to work, as in cases of anemia or certain arrhythmias. The main cause of heart artery disease (coronary artery disease) is arteriosclerosis. Plaques develop inside the arteries: cholesterol, inflammatory cells, calcium and blood cells involved in blood clotting, which can narrow or even completely block the coronary artery.
There are several causes of coronary arteriosclerosis: diabetes, tobacco use, high blood pressure, high cholesterol levels, family history, aging and stress. There are some of them that cannot be modified, such as family history and the passage of time, but we can act on the other risk factors with changes in lifestyle habits and the help of drugs.
How is ischemic heart disease diagnosed?
When consulting a cardiologist to rule out coronary artery disease, the main thing to do is to take a medical history that includes family history, tobacco use, associated diseases and lifestyle habits, as well as to clearly establish the symptoms of the patient.
A physical examination and the recording of an electrocardiogram (ECG) at rest are also performed. The fact that the resting ECG is normal is good news, but does not rule out ischemic heart disease since the ECG shows the electrical activity of the heart at the time of recording and does not rule out the possibility that it may be altered in another situation.
Depending on the data obtained during this visit, the type of examinations required to establish the diagnosis will be established: analysis, stress test and echocardiogram, which are the examinations usually performed, or in some cases more specific tests: isotopic stress test, cardiac MRI, CT of coronary arteries or coronary angiography.
What symptoms are experienced in ischemic heart disease?
The main symptom is chest pain; as less blood reaches the heart muscle, it manifests pain, known as “angina pectoris”, but not all chest pains are due to heart artery disease, as they may be due to other reasons of muscular, digestive or respiratory origin. For this reason it is important to consult a doctor to assess whether the type of pain is due to a cardiac origin.
In principle, pain in the middle of the chest, intense, oppressive in nature, radiating to the shoulders, arms or jaws and accompanied by general malaise with nausea, sweating or choking, requires immediate medical evaluation. On occasion, coronary artery disease may manifest itself without pain, in the form of choking, palpitations or loss of consciousness.
If adequate blood flow through the arteries of the heart is not restored, and the heart muscle continues to suffer from a lack of blood, we are at risk of suffering a myocardial infarction. The difference between angina pectoris and myocardial infarction is that while in the first case the heart experiences pain due to a reduction in the blood supply it needs, if the flow is restored, the heart will not have been damaged in its structure and there will be no scarring. In the case of infarction, the blood supply through one of the coronary arteries is completely interrupted and a scar is produced in the heart that remains, even if the blood flow is later restored.
What is the best treatment for ischemic heart disease?
The best treatment is prevention. A healthy lifestyle without smoking, with moderate physical exercise, a Mediterranean diet and making sure that blood pressure, cholesterol and sugar levels are controlled are the best prevention for ischemic heart disease.
If the disease is nevertheless established, treatment will depend on each patient and the severity of the involvement of the heart arteries. In some cases, medical treatment will be sufficient to allow blood to circulate more easily through the coronary arteries, making it more fluid and slightly dilating the caliber of the arteries with medication.
In other cases it will be necessary to see exactly the type of narrowing and its location in the coronary arteries in order to try, by means of a catheter equipped with a balloon with an inflation system at its end, to access the site of the narrowing to dilate it and place a small metal cylinder (stent) in this position to keep the artery open. This procedure is performed without surgery by puncturing an artery at the level of the wrist or groin.
In the event of a myocardial infarction with more prolonged pain, the emergency medical service (EMS) should be contacted immediately. After confirming with the help of blood tests and ECG that it is indeed an infarction, through an established program (infarction code), the patient is immediately transferred to the nearest hospital with the possibility of performing a cardiac catheterization in order to locate the blocked artery and unblock it immediately, thus avoiding the infarction or at least reducing the extent of the scarring.