Ischaemic Heart Disease
Overview
Ischaemic heart disease, also known as coronary artery disease, occurs when one or more of the major arteries that supply the heart (called coronary arteries) become significantly blocked, to the extent that the oxygen demand of the heart muscle cannot be met, due to the reduced blood flow through the coronary arteries. The blood is responsible for delivering oxygen and other nutrients to all organs in the body. The heart muscle needs oxygen to pump properly and requires a constant blood supply. Reduced blood flow to the heart muscle may cause chest pain (angina). If the blood flow to the heart muscle is reduced significantly or is completely blocked, a heart attack can occur.
Symptoms
The most common symptom of ischaemic heart disease is the feeling of pressure or pain in the chest, often on the left side of the body. Other symptoms that may be experienced include:
- Pain in the neck and or jaw
- Pain through the shoulder or arm
- A rapid heart rate
- Increased shortness of breath when exercising
- Increased fatigue when performing your regular activities
Not all patients who have ischaemic heart disease will experience symptoms, this is called silent ischaemia.
Causes
Ischaemic heart disease usually take many years to develop, as the arteries are slowly blocked over time through the build up of plaque deposits. There are also cases where the disease can develop quickly, for example due to smoking and increased cholesterol. In some instances, the artery becomes suddenly blocked due to the artery tearing (called dissection), or when a soft cholesterol plaque ruptures (eg during extreme exertion) and exposes a surface which blood cells, called “platelets” try to “repair” by building up on the exposed surface to cover it (similar to when you have a skin bleed). In some instances, the platelet build up blocks off the artery very quickly, so that no blood can go through beyond the plaque. This can then cause a heart attack, and can cause permanent heart muscle damage if the blockage is not opened up soon.
The main cause of ischaemic heart disease is Atherosclerosis. This is the build up of plaque deposits that are made mostly of cholesterol. As the plaque continues to thicken on the artery walls, the blood flow to the heart is restricted.
The symptoms associated with ischaemic heart disease can be triggered by:
- Exercise or physical exertion
- Anxiety or emotional stress
- Eating large meals
- Sexual intercourse
What are the risk factors associated with IHD?
Certain lifestyle factors and medical conditions can increase your risk of developing ischaemic heart disease.
- Smoking (tobacco or marijuana): Continued smoking, a history of smoking or exposure to second hand smoke can increase the risk of developing IHD. Smoking damages the walls of the arteries, this allows deposits of plaque and cholesterol to collect on the damaged wall and reduce the flow of blood to the heart. Smoking also increases the risk of spasms of the arteries and blood clots which can both lead to sudden myocardial ischaemia.
- Diabetes: Both type 1 and type 2 diabetes increase the risk of not only ischaemic heart disease, but also other heart related issues.
- High blood pressure: High blood pressure can lead to an accelerated rate of atherosclerosis which may cause damage to the coronary arteries.
- High cholesterol and trigylcerides: Cholesterol and triglycerides, both types of fats, are largely responsible for plaque deposits in the coronary arteries that reduce the blood flow to your heart.
- Obesity: Obesity increases the risk of other factors such as diabetes, high blood pressure and high cholesterol, all of which can increase your risk of ischaemic heart disease.
- Increased waist circumference: Waist measurements of more than 89cm for women, and 102cm for men, increase the risk of other factors such as high blood pressure, diabetes and heart disease.
- Lack of exercise: A sedentary lifestyle contributes to obesity and is linked to hypertension, increased cholesterol and triglyceride levels. Performing regular exercise, where your heart rate is elevated, maintains good heart health and is associated with lower risk of heart conditions, such as ischaemic heart disease and heart attack. The National Heart Foundation recommends half an hour of moderate intensity exercise 5 days a week for cardiovascular health. For more information Click Here
Diagnosing Ischaemic Heart Disease
When you attend your appointment, we will ask you many questions about your lifestyle, your medical history and your family history. Using this information, and the symptoms that you have experienced, we may recommend:
- Echocardiogram
- Stress echocardiogram
- ECG
- Cardiac CT
- Coronary Angiography
Prevention and Treatment
Leading a healthy, active lifestyle is the best way to prevent ischaemic heart disease from developing, and reducing the risk factors above helps to treat the condition too. When treating ischaemic heart disease, we aim to improve blood flow to the heart muscle. This can be done using either medication, surgery, or both. The treatment pathway will depend on the severity of your condition.
The procedures used to improve blood flow include:
- Angioplasty and stenting
- Coronary artery bypass surgery
