Ischemic heart disease

Ischemic heart disease

Definition

It is cardiac damage because of an inadequate coronary blood supply, Generally, it is due to the narrowing of the coronary arteries from atherosclerosis. 

  • There are three synonyms
  • Ischemic heart disease
  • Coronary artery disease
  • Coronary heart disease



Ischemic heart disease can manifest in various presentations clinically:

  • Angina pectoris- It is an episodic clinical syndrome, in which the pain is of shorter duration, without any permanent damage to the myocardium, or in other words the ischemia of Angina a reversible and transient.
  • Acute myocardial infarction
  • Sudden death
  • Cardiac failure
  • Arrhythmias
  • Connective tissue disorders
  • Conduction defects
  • Shock


Symptoms / Signs

  • It is usually described as constricting or crushing in type, heaviness, squeezing, or choking. There can be discomfort or unpleasant sensation of pressure in place of actual pain.
  • Pain and is felt behind the sternum or across the chest, radiation to left shoulder, to both arms, even to the capsular area or jaw. Here the most common symptom is chest pain.
  • Most of the attacks of Angina are of short duration and subside within 30 minutes.
  • It may be described as indigestion or gas.
  • Pain has definite relation to exercise, emotions, sexual activity, after meals.
  • There will be tachycardia, sweating, and shortness of breath, raise in Blood Pressure.
  • Signs of diabetes, hormonal diseases, cigarette smoking, cardiac enlargement, and evidence of hypertension must be elicited.


Risk factors

Fixed

  • Age
  • Male sex
  • Positive family history


Potentially changeable with treatment

Strong association:

  • Hypertension
  • Hyperlipidemia
  • Cigarette smoking
  • Diabetes mellitus
  • Rheumatoid arthritis
  • Systemic lupus erythematosus 


Weak association:

  • Personality
  • Obesity
  • Gout
  • Lack of exercise
  • Contraceptive pill
  • Heavy alcohol consumption 


Indication for coronary angiography:

  • Angina refractory to medical therapy
  • Severely abnormal exercise ECG
  • Unstable angina
  • Subendocardial myocardial infarction


Investigation:

  • History often is very characteristic
  • Urine for diabetes
  • Blood for Lipid profile, Glucose, Creatinine, CBC
  • Chest X-Ray
  • Coronary arteriography
  • ECG
  • PET (Positron Emission Tomography)


Diet:

A diet with abundant fruits and vegetables lowers the risk of cardiovascular disease and death. 


Vegetarians have a lower risk of heart disease, possibly due to their greater consumption of fruits and vegetables. Evidence also suggests that the Mediterranean diet and a high fiber diet lower the risk.


The consumption of saturated fatty acid which is found in fry or unhealthy oil etc. or trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause a precursor to atherosclerosis and increase the risk of coronary artery disease.


Proof does not allow a beneficial role for omega-3 fatty acid supplementation in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death).


Precaution:

  • Explain to the patient that this pain arises from the stressed heart
  • Reassurance o good prognosis
  • Check emotional worries and strains
  • Advise exercises
  • Obesity and anemia must be corrected if present
  • Meals should be small, eaten slowly, and followed by a rest period
  • Cigarette smoking and consuming alcohol must be stopped


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