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Coronary heart disease is a condition where the fatty material called plaque, accumulates inside the coronary artery causing its narrowing and blockage.
Ischemic heart disease is a condition where the coronary artery becomes significantly narrowed, to not allow enough blood to reach the heart muscles leading to symptoms and even heart attack.
Coronary artery disease is one of the causes of ischemic heart disease and not all cases of coronary artery disease result in a lack of blood flow. However, plaque accumulation is an ongoing process and could eventually lead to damage and heart attack.
It is thus important to treat coronary and ischemic heart disease at any given stage.
The most recognizable symptom of ischemic heart disease is typical chest pain called angina, shortness of breath, or heart attack.
Some people may have other symptoms that are usually non-specific and may remain unnoticed until they present with a sudden heart attack termed as a silent heart attack.
Angina (chest pain): usually, a person experiences a typical squeezing, tightness, or pressure-like pain in the center or left side of the chest. The pain may also involve the left arm, shoulder, back, neck, or jaw. The pain may sometimes feel like indigestion with a burning kind of sensation.
The pain typically starts with some physical or emotional stress and resolves in some minutes after removing the stress or taking rest.
Heart attack: typically, the person has severe crushing or squeezing pain in the chest and shoulder or arm, which may typically occur on rest and doesn’t go away on its own.
Shortness of breath: this typically occurs with activity. The heart pumps blood inadequately resulting in shortness of breath.
The other non-specific signs and symptoms that may occur are:
• Neck pain
• Sudden heavy sweating
• Feeling restless or anxious
Symptoms in women: women more often have non-specific symptoms such as pain in the neck, jaw or abdomen or nausea, vomiting, fatigue, or dizziness.
Ischemic heart disease which is itself a complication of coronary artery disease can further lead to the following serious conditions:
1. Acute coronary syndrome: a condition that occurs due to the rupture of the plaque, causing blockage of the coronary artery. It is a life-threatening complication that requires emergency treatment.
On the basis, of duration and location of the blockage and the amount of damage, this may lead to the following 3 complications:
Unstable angina: this angina occurs more often, more at rest, lasts for a longer period, and is more severe in intensity. This may progress to heart attack and requires treatment with a procedure.
Non-ST segment elevation myocardial infarction/heart attack (NSTEMI): this type of heart attack doesn’t show any changes on ECG. However, when blood test for cardiac markers is done it suggests damage to the heart. The extent of heart damage is relatively smaller due to the partial or temporary blockage of the coronary artery.
ST-segment elevation myocardial infarction/heart attack (STEMI): this type of heart attack shows typical changes on both ECG and blood tests for cardiac markers. Here the damage is sudden and for a longer time, thus affects a large area of heart muscles.
2. Sudden cardiac arrest (SCA): ischemic heart disease is considered to cause most of the sudden cardiac arrest, where the heart stops beating completely leading to death. This is different from a heart attack where the heart doesn’t stop beating suddenly and only a portion of the heart is damaged. However, a heart attack may eventually lead to SCA.
3. Heart failure: a long-standing decreased flow of blood or heart attack may cause damage to a portion of the heart making it weak. This results in a decreased ability of the heart to pump blood adequately known as heart failure.
4. Cardiogenic shock: heart attack is the commonest cause of cardiogenic shock. Heart failure may also lead to cardiogenic shock.
5. Arrhythmia (abnormal rhythm of the heart): Decreased blood to heart or damage to a portion of heart can affect the heart’s ability to granite or spread electrical impulses, resulting in abnormal heart rhythms.
The coronary arteries are blood vessels that supply oxygen-rich blood to the heart which allows the heart to function. These vessels travel along the surface and into the substance of the heart supplying blood to various parts.
The coronary artery disease occurs when there is an accumulation of a fatty substance called plaque, along the inner surface of the coronary arteries resulting in narrowing of the coronary artery.
The ischemic heart disease occurs when there is significant narrowing of the coronary artery resulting in an inadequate supply of blood to the heart muscles leading to symptoms as described above.
The narrowing of the coronary artery can occur due to plaque or blood clots formation within the vessels or due to spasm of the coronary artery.
Plaque: As a person ages, the accumulation of fat increases inside the coronary arteries. This may also cause some injury to the vessel wall. This may further allow other substances in blood like inflammatory cells, waste products, and calcium to stick together with fat to form a substance called plaque. This plaque causes significant or insignificant narrowing of the arteries depending on the size, thickness, and location. Plaque causing more than 50% narrowing of the vessel is considered significant.
Blood clot: sometimes the plaques can break exposing the inner diseased surface. This may cause platelets (blood cells that play a role in clot formation) to come and accumulate onto the surface forming a blood clot at the site. The clot may lead to partial and many times complete narrowing of the artery resulting to complete obstruction of blood supply.
Spasm of the artery: the inflammation produced during the process of endothelial injury, plaque formation, and plaque breakage may also alter the muscle contraction of the arteries. These arteries may not respond well to increased blood demand during stress or physical activity. The arteries may not dilate or even contract at these times to further reduce the blood flow.
There are many factors that predispose a person to develop CAD. These factors can be categorized into modifiable and non-modifiable factors on the basis of what can be controlled or treated:
Modifiable factors: these are the factors that are developed during a lifetime that can be treated or controlled.
Smoking: smoking tobacco in any form such as cigarettes, bidi, or cigar or inhaling the smoke sitting next to a person who’s smoking both can lead to the development of plaques with the arteries.
Air pollution: s found to cause or worsen other conditions like plaque formation or high BP which can further lead to ischemic heart disease. It more significantly affects women, elderly, obese and diabetics.
Mental stress: can directly cause narrowing of the coronary arteries resulting into decreased blood flow. Moreover, it can lead a person to form habits of smoking or over eating especially, food rich in sugar and saturated fats to counter stress. The person may also develop high BP.
Unhealthy diet: eating high amount food rich in saturated fats, trans fat, sugar and salt are known to cause build up plaque, increases chances of other risk factors like high blood cholesterol and TG level and high BP.
Physical inactivity: increases the risk of other factors like increased weight, decreased ability to cope up with mental stress, increased cholesterol and triglyceride levels and others.
Overweight: being overweight or obese with Body mass index of more than 25 kg/m2 has been found to be significantly associated with other risk factors.
High blood cholesterol and triglyceride levels: are important risk factors, especially high bad cholesterol (LDL) above 100 mg/dL and low good cholesterol (HDL) under 40 mg/dL.
High blood pressure: long standing high BP may cause hardening and narrowing of the arteries.
Diabetes: uncontrolled diabetes, HbA1c of more than 7.0 is found to be an important risk factors.
Chronic kidney disease: it is associated with increased risk of high BP.
Non modifiable or Inborn factors:
Age: with increasing age, there occurs increase in chances of build up of plaques in arteries especially in people with genetic susceptibility and poor lifestyle habits. There is increased risk of CAD in men over 40 and in women over 50 years of age.
Sex: men are more prone to develop CAD than women before menopause. After menopause the risk of development become same. Women may have more chances of developing CAD if they suffer from endometriosis, PCOS, pregnancy induced diabetes, pre-eclampsia.
Family history: a history of early CAD in family especially in parents or siblings increase the chances of developing CAD.
Race: Asians are at more risk of developing this disease.
The risk of developing coronary artery disease increases with the type and number of risk factors present in a person.
It is more common in urban population where it is said to affect about 1 in 10 people.
There is also increase in the number of deaths due CAD. It is estimated to cause death in about 23% of all patients of CAD and 32% of adult population.
To check for the risk of developing CAD or IHD following things are done:
1. History taking: involving following
• Clinical history- regarding any symptoms or complaints,
• Personal history- type of work, stress level, physical activity
• Family history- to know about any family member having heart disease, coronary artery or any associated risk factors.
2. Assessment of BP and heart rate: BP over 140/90 mmHg is considered high.
3. Calculation of body mass index (BMI): to see if you are overweight (BMI 25–29 kg/m2) or obese (BMI more than 30 kg/m2), which are rock faros for CAD.
4. Blood tests: are done to check for high blood cholesterol and triglycerides levels and to check for diabetes.
There is a useful tool available that allows you to check the probability to develop heart attack or die from IHD in next 10 years:
To calculate your risk click on: Atherosclerotic Cardiovascular Disease Estimator
• High risk: suggest more than 20% risk of developing a heart attack or dying from IHD in the next 10 years.
• Intermediate risk: suggest 10 to 20% risk of developing a heart attack or dying from IHD in the next 10 years.
• Low risk: Less than 10 % risk of developing a heart attack or dying from IHD in the next 10 years.
This can be helpful for people to understand their risk objectively and start working on modifiable risk factors to prevent development of complications.
It is advisable for people with no obvious CAD or IHD, to get themselves assessed after every 4-5 years starting from the age of 20. In people, with CAD or IHD, it is important to follow up regularly as advised by their doctors.
It has been found that modifiable risk factors play a big role in the development of coronary heart disease. These factors if prevented by adopting a heart-healthy lifestyle can work wonder in the prevention and early treatment of CHD.
These are as follows:
1. Eating healthy diet with low saturated fat, trans fats, salt, and sugar. Increasing the diet rich in fibers like fruits, salads also help to keeps check on cholesterol levels.
2. Being physically active and exercising: this maintains the cardiovascular functioning and prevents from developing other risk factors like overweight, stress, and others.
3. Keeping control over high cholesterol, high BP, and blood sugar levels by following proper and regular treatment.
4. Quit smoking
5. Avoiding and managing stress
6. Maintaining a healthy body weight
CAD/IHD is diagnosed in the following manner:
History: the doctors start with asking your symptoms, personal and family history, where focus is made on checking for the presence of risk factors.
Your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes, including:
• Aiming for a healthy weight. Losing just 3 percent to 5 percent of your current weight can help you manage some ischemic heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
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