Ischemic Heart Disease

What is ischemic heart disease?

Ischemic heart disease (IHD), also known as coronary artery disease (CAD) or coronary heart disease (CHD), is a prevalent cardiovascular condition that remains a leading cause of morbidity and mortality worldwide. Characterised by the reduced blood supply to the heart muscle, IHD primarily occurs due to the build up of fatty deposits, known as plaque, within the coronary arteries. These arteries play a crucial role in supplying oxygen and nutrients to the heart muscle, and when they become narrowed or blocked, the heart’s blood flow is compromised, leading to various complications.

Types of ischemic heart disease

There are several types of ischemic heart disease, each presenting its own set of challenges and considerations:

a. Stable angina: This is characterised by temporary chest discomfort or pain, often triggered by physical activity or stress. The pain typically subsides with rest.

b. Unstable angina: More severe than stable angina, this type involves unexpected chest pain or discomfort even at rest. It may signal an impending heart attack.

c. Myocardial infarction (Heart attack): Occurs when the blood supply to a part of the heart muscle is blocked, leading to damage or death of that muscle tissue. This is a medical emergency requiring immediate attention.

d. Silent ischemia: Some individuals with IHD may not experience any noticeable symptoms, making it challenging to detect. However, the underlying damage to the heart muscle still occurs.

Causes of ischemic heart disease

The primary cause of ischemic heart disease is atherosclerosis, a condition where the coronary arteries become narrowed due to the build up of cholesterol, fat, and other substances. The risk factors for developing IHD include:

a. Smoking: Tobacco smoke contains chemicals that can damage blood vessels, leading to atherosclerosis.

b. High blood pressure: Hypertension puts strain on the heart and can contribute to the development of IHD.

c. High cholesterol: Elevated levels of LDL cholesterol can lead to the formation of plaque in the coronary arteries.

d. Diabetes: Individuals with diabetes are at an increased risk of developing IHD.

e. Sedentary lifestyle: Lack of physical activity can contribute to obesity and other risk factors for IHD.

f. Age and gender: The risk of IHD increases with age, and men are generally more susceptible than premenopausal women.

Symptoms of ischemic heart disease

Recognising the symptoms of ischemic heart disease is crucial for early intervention. Common signs include:

a. Chest pain or discomfort: This is a classic symptom, often described as a squeezing, pressure, fullness, or pain in the chest.

b. Shortness of breath: Difficulty breathing or catching one’s breath may occur, especially during physical activity.

c. Fatigue: Unexplained fatigue or weakness may be a sign of reduced blood flow to the heart.

d. Sweating: Excessive sweating, often accompanied by cold and clammy skin, can be a symptom of IHD.

e. Nausea and dizziness: Some individuals may experience nausea, light headedness, or dizziness.

Risks and complications associated with ischemic heart disease

Without proper treatment, ischemic heart disease can lead to severe complications, including:

a. Heart attack: The most critical complication, a heart attack occurs when blood flow to a part of the heart is completely blocked, resulting in damage to the heart muscle.

b. Heart failure: Chronic ischemic heart disease can weaken the heart over time, leading to heart failure, where the heart is unable to pump blood effectively.

c. Arrhythmias: IHD can disrupt the heart’s normal rhythm, leading to irregular heartbeats.

d. Stroke: Individuals with IHD are at an increased risk of developing blood clots, which can travel to the brain and cause a stroke.

e. Sudden cardiac death: In some cases, IHD can lead to a sudden and unexpected loss of heart function, resulting in cardiac arrest.

Treatment available for ischemic heart disease

The management of ischemic heart disease involves a comprehensive approach aimed at alleviating symptoms, preventing complications, and improving overall heart health. Treatment options include:

a. Medications: Drugs such as antiplatelets, statins, beta-blockers, and nitro-glycerine may be prescribed to manage symptoms and reduce the risk of complications.

b. Lifestyle changes: Adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, smoking cessation, and stress management, is essential in managing IHD.

c. Angioplasty and stent placement (PCI): In cases of significant arterial blockage, a procedure known as angioplasty may be performed to open the narrowed artery, often accompanied by stent placement to maintain blood flow.

d. Coronary artery bypass grafting (CABG): In severe cases, where multiple arteries are blocked, especially in diabetic patients, CABG surgery may be recommended. This involves redirecting blood flow around the blocked arteries using new grafts. In some cases when the disease involves one artery in a long segment or a location not favourable for PCI, then CABG is recommended.
Our expertise covers a spectrum of therapeutic surgical techniques: –
• Total arterial coronary artery bypass grafting (CABG)
• Off-pump (beating heart) coronary artery bypass grafting (OPCAB)
• Minimally invasive direct coronary artery bypass (MIDCAB)
• Minimally invasive coronary artery bypass grafting (mini-CABG)