Ischemic Heart Disease: Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prognosis and Prevention

The term ischemia means that an inadequate blood supply reaches a part of the body.

Ischemic heart disease means that not enough blood is reaching the heart muscle .

It is almost always caused by atherosclerosis, a narrowing of the arteries due to fatty deposits on their inner walls in the coronary arteries (the arteries that supply the heart muscle, and is the most common cause of heart disease).

The prevalence of ischemia increases with age. The first manifestation of ischemic heart disease is sometimes a fatal heart attack, but the presence of the condition can be signaled by symptoms that should prompt life-saving actions.

Knowing these symptoms can mean living longer. And preventing heart disease generally means living happier, without symptoms or functional limitations.

Ischemic heart disease, also called coronary artery disease , is a common term for a build-up of plaque (fatty material) in the arteries of the heart, causing them to narrow.

This buildup is known as atherosclerosis, and it causes reduced blood and oxygen flow to the heart (ischemia), which can lead to many serious and chronic health problems.

Acute manifestations of atherosclerosis include angina (chest aches and pains) and heart attack.

Heart attack, or acute myocardial infarction, is a life-threatening event that occurs when there is a complete blockage of the blood vessel, depriving the heart of oxygen and causing cell death and permanent damage.

People with chronic ischemic heart disease may not realize they have this condition until they experience angina or a heart attack.

Ischemic heart disease is a condition in which the heart muscle becomes weak as a result of a heart attack or coronary artery disease.

In ischemic heart disease, the arteries that supply blood to the heart muscle narrow.

This can prevent necessary blood from reaching parts of your heart muscle, causing damage.

If you develop ischemic heart disease, your heart’s left ventricle will likely enlarge, dilate, and weaken.

This inhibits your heart’s ability to pump blood properly, which can lead to heart failure.

Causes and risk factors

There are a number of risk factors for developing ischemic heart disease. Some of these cannot be prevented and include advanced age and a family history of the disease. However, most risk factors are modifiable.

Modifying these controllable risk factors produces benefits both in terms of reducing the likelihood of developing heart disease and limiting the progression of the disease, once acquired.

Risk factors include:

  • Age: Getting older increases the risk of arteries being damaged and narrowed.
  • Sex: Men are usually at higher risk for coronary artery disease. And for women the risk increases after reaching menopause.
  • Heredity: a family history of heart disease is always associated with an increased risk of coronary artery disease, especially if heart disease has developed in relatives at an early age.
  • Tobacco – Smokers have a higher risk of heart disease.
  • High blood pressure: the hardening and thickening of the arteries, can be caused by uncontrolled blood pressure.
  • High levels of cholesterol in the blood: this factor can increase the risk of plaque formation and atherosclerosis.
  • Diabetes: This disease is associated with an increased risk of coronary artery disease. Type diabetes, obesity, and high blood pressure share similar risk factors for coronary artery disease.
  • Obesity: excess weight in the patient generally increases the risk of other factors.
  • Exercise: sedentary lifestyle or lack of physical activity is associated with ischemic heart disease.
  • Stress: the stress is not relieved in your life can damage your arteries and worsen other risk factors for coronary artery disease.
  • Unhealthy diet: Eating too much food that is high in saturated fat, trans fat, salt, and sugar can increase your risk of coronary artery disease.

Obesity generally leads to type 2 diabetes and high blood pressure.

Metabolic syndrome is a cluster of conditions that includes high blood pressure, high triglycerides, low HDL, high insulin levels, and excess body fat around the waist.

When certain factors are grouped together, they increase the risk of developing ischemic heart disease. However, there have been cases in which the disease develops without any classical risk factor.

For this reason, other possible factors that influence the appearance of the disease are being studied, such as:

  • Sleep apnea: This disorder causes you to repeatedly stop and start breathing while you sleep. These drops in blood that occur during sleep apnea, cause oxygen levels, increase blood pressure, affecting the cardiovascular system.
  • High sensitivity C-reactive protein: this is a protein that increases its levels when an inflammatory process occurs somewhere in the body. High levels of this protein can be a risk factor for heart disease.
  • High levels of triglycerides: High levels of this lipid in the blood can increase the risk of coronary artery disease, especially in the case of women.
  • Homocysteine: This is an amino acid that the body uses to make proteins, build and maintain tissues. High levels of this protein can increase the risk of developing coronary artery disease.
  • The preeclampsia : this condition that can develop in women during pregnancy causes high blood pressure and an increased amount of protein in the urine. It can lead to an increased risk of heart disease later in life.
  • Alcohol consumption : Excessive alcohol consumption can cause damage to the heart muscle. It can also worsen other risk factors for coronary artery disease.
  • Autoimmune diseases: Conditions such as rheumatoid arthritis, lupus, and other inflammatory rheumatologic conditions have an increased risk of atherosclerosis.
  • Other diseases: such as end-stage kidney disease, amyloidosis, a condition in which abnormal proteins build up in tissues and organs, including blood vessels.

Symptoms of ischemic cardiomyopathy

When the coronary arteries narrow, they are not able to supply enough oxygen-rich blood to the heart, especially when exerting physical effort.

At first, decreased blood flow may not cause any symptoms of coronary artery disease.

But, when plaque builds up in the coronary arteries, some signs and symptoms of the disease can develop including:

  • Angina pectoris – You may feel pressure or tightness in the chest, which usually occurs on the middle or left side of the chest. This symptom is usually triggered by physical or emotional stress. The pain usually goes away within minutes after stopping stressful activity. This pain may be felt in the neck, arm, or back in a fleeting or acute way.
  • Shortness of breath: When the heart cannot pump enough blood to meet the body’s needs, extreme fatigue can develop with exertion.
  • Heart attack: when the coronary artery is totally blocked it causes a heart attack. Signs and symptoms include pressure in the chest and pain in the shoulder or arm, and sometimes shortness of breath and excessive sweating occur.

However, occasionally, a heart attack occurs with no apparent signs or symptoms.

Diagnosis

If your doctor suspects you have ischemic heart disease, they will perform a physical exam, and they will likely order more tests to develop their diagnosis such as:

  • Blood tests to measure the level of cholesterol and triglycerides in the blood.
  • Imaging tests, such as X-rays, CT scan, or MRI.
  • Echocardiogram to evaluate the anatomy and function of the heart using ultrasound waves.
  • Electrocardiogram to record electrical activity in the heart.
  • Stress test to monitor the heart’s ability to exert a lot of effort.
  • Cardiac catheterization, in which a coronary angiogram is done to check for narrowing within the arteries.
  • Myocardial biopsy to collect and analyze a small sample of tissue from your heart muscle

Treatment of ischemic heart disease

The doctor must first address the underlying cause of ischemic heart disease to treat it.

Your doctor’s prescribed treatment plan will take into account how much damage your heart has suffered while treating the underlying cause of ischemic heart disease, to prevent further progression of the disease, to help improve your cardiovascular function, and to treat any associated symptoms.

A combination of lifestyle changes, medications, surgery, or other procedures may be recommended.

Healthy lifestyle choices can help reduce your risk of complications and lower your chances of developing ischemic heart disease in the first place.

Changes in lifestyle

To help treat coronary artery disease and reduce the risk of complications, eat a healthy diet low in saturated fat, cholesterol, and sodium. Exercise will also be recommended for you safely for your condition.

Your doctor will probably advise you to quit smoking, avoid drugs, and drink less alcohol.

These lifestyle changes should not be approached as short-term solutions. Rather, the patient must commit to developing long-term healthy habits.

Medicines

Your doctor may prescribe medications to help relieve symptoms, prevent complications, and improve heart function.

Depending on your circumstances, they may prescribe:

  • A beta blocker to lower your blood pressure and heart rate.
  • A calcium channel blocker to relax and widen the arteries and lower blood pressure.
  • An aldosterone inhibitor to lower blood pressure and remove excess fluid in the body to help relieve symptoms, such as swelling and shortness of breath.
  • Other types of diuretics to remove excess fluids, lower blood pressure, and reduce the amount of work the heart muscle has to do.
  • A drug therapy to control the heart rhythm.
  • An anticoagulant.
  • A medicine to treat high cholesterol.

Surgery and other procedures

Your doctor may also recommend surgery or other procedures that involve the coronary arteries or other parts of your heart.

For example, they may recommend:

  • The implantation of a pacemaker, defibrillator, or both to improve the electrical function of your heart.
  • An atherectomy to remove plaque from the arteries.
  • Balloon angioplasty to help improve blood flow in narrow arteries.
  • The insertion of a stent, a device designed to keep the arteries open.
  • Radiation therapy after the lumen in a previously placed arterial stent is repeatedly narrowed, to try to prevent the artery lumen from narrowing again.
  • In very serious cases, your doctor may recommend a coronary artery bypass graft.

During this open chest surgery, the surgeon will remove a part of a healthy blood vessel from another part of your body and reconnect it to the heart to restore the arterial blood supply.

This allows blood to bypass the blocked artery segment, which flows through the new blood vessel and connects to the coronary artery below the blocking segment.

If the damage to your heart is too great to repair, you may need a heart transplant.

Prognosis of ischemic heart disease

If left untreated, ischemic heart disease can lead to blood clots, heart failure, and even death.

Treating the underlying cause of your ischemic heart disease is critical to preventing complications.

Your long-term outlook will depend on several factors, including:

  • How much damage the heart has suffered.
  • The effectiveness of the treatment.
  • Choices in lifestyle.

Complications are more likely to develop if:

  • High-risk lifestyle decisions are made, such as smoking tobacco or abusing alcohol.
  • Not taking prescribed medications properly.
  • Developing an infection.
  • Have other important health conditions.

Prevention of ischemic heart disease

First of all, you can reduce your chances of developing heart disease by choosing suitable lifestyles such as:

  • Control blood pressure, cholesterol levels, and diabetes.
  • Do aerobic exercise for at least 30 minutes, five times a week.
  • Do not smoke, avoid alcohol consumption, do not abuse drugs.
  • Eat a healthy diet low in fat and salt, rich in fresh fruits and vegetables, and whole grains.
  • Keep a healthy weight.
  • Reduce and manage stress.

By practicing heart-healthy habits, you can reduce your risk of developing coronary artery disease, ischemic heart disease, and other cardiovascular conditions.

If you’ve already developed ischemic heart disease, healthy lifestyle choices can help mitigate complications.