Ischemic Heart Disease is a condition that occurs when your heart muscles aren’t getting enough blood. This can lead to heart attacks, strokes, blood clots and other health problems.
Your doctor and heart care team will present you with all of your options to prevent progression of atherosclerosis, limit complications and restore functional capacity. These include risk modification, guideline-directed medical therapy and revascularization.
Atherosclerosis
When the inner wall of an artery is damaged, it creates chemical signals that cause certain white blood cells to move into the area. These cells may transform into foam cells that collect cholesterol and other fatty substances. Over time, these deposits build up and form patchy areas (atheromas) in the artery walls. If these plaques break open, a blood clot forms and blocks the flow of blood through that part of the artery. If the clot reaches the heart, it can cause chest pain or a heart attack. When the clot blocks an artery to the brain, it causes a stroke.
Atherosclerosis occurs when fatty deposits build up in medium-sized and large arteries. These arteries supply oxygen-rich blood to organs and tissues throughout the body. The deposits are made up of fats, cholesterol and other fatty substances and a sticky substance called plaque. This process is sometimes called arteriosclerosis or hardening of the arteries.
Smaller arteries also can develop atherosclerosis. This condition is more common in younger people and affects men more often than women. The condition can start in any artery in the body, but it most often appears in those that supply blood to the brain, stomach, legs and kidneys.
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Symptoms of atherosclerosis vary and depend on which arteries are affected. If the arteries that supply blood to your brain or heart are affected, you may have headaches, weakness or numbness in your arms or legs, or trouble seeing in one or both eyes. You might have a sharp pain in your chest that comes and goes, or you might have difficulty breathing.
If you have atherosclerosis, your health care provider will ask about your symptoms and family history of heart disease. He or she will do a physical exam and listen to your heart using a stethoscope. He or she will also test your blood pressure and check your heartbeat with a holter monitor or electrocardiogram. Other tests that may be used include a chest X-ray, an echocardiogram or computerized tomography (CT) scan. Your provider will recommend lifestyle changes and medicine to lower your risk of heart disease.
Coronary artery disease
When the heart beats, it pumps blood around the body, carrying oxygen to every cell. The heart muscle needs enough oxygen-rich blood to work normally, and it gets the blood it needs from the coronary arteries that run along its outside surface. These arteries have small branches that supply blood to different parts of the heart. There are 2 main coronary arteries—the left anterior descending artery, which supplies the front of the heart; and the right coronary artery, which encircles the heart.
If the arteries are narrowed, less blood and oxygen reach the heart, which causes the chest pain or discomfort known as angina. The pain may start when you exercise, or it may happen at rest. It may get worse over time. Unstable angina is often a sign of more serious problems, including a heart attack.
A blood clot in an artery that provides the heart with its oxygen can block the flow of blood and cause a heart attack. The clot can be caused by plaque that breaks apart, blood that settles in a narrow coronary artery, or damage to the artery wall lining. It can also be a sign of other conditions, such as a spontaneous coronary artery dissection (SCAD) or a tear in the artery wall that allows blood to pass through the artery and cause a thrombosis.
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In other cases, the artery doesn’t have any plaque buildup and still narrows. This can be due to other factors, such as irregular constrictions in the artery (coronary vasospasm), abnormal connections between arteries and other structures in the heart (myocardial bridging), or damage to the artery lining (endothelial dysfunction).
Many people have no symptoms when they have a narrowing of the coronary arteries. Sometimes, the only symptom is a heart attack, which can be a life-changing event. It’s important to take the time to build a plan to help your heart, and to get treatment if needed. A doctor can give you advice and support to make changes that will improve your health and increase the chances of a full recovery.
Silent ischemia
Silent ischemia happens when a narrowing or blockage briefly prevents oxygen-rich blood from reaching your heart. If it persists for too long, the heart can’t keep up with its needs and you may feel chest pain (angina). When this occurs, it’s called symptomatic ischemia. In other cases, however, the symptoms don’t occur. This is called silent ischemia or atypical myocardial infarction.
People with a history of coronary artery disease or diabetes are at risk for silent ischemia. It’s also more common in people who have had a heart attack. Silent ischemia can be detected by tests such as an exercise stress test, an electrocardiogram, or an echocardiogram.
Ischemia can have many causes, including plaque that breaks apart and creates a blood clot. Another cause is coronary artery spasm, which temporarily reduces or cuts off blood flow to your heart. Other causes include abnormal heart rhythms, such as ventricular tachycardia or ventricular fibrillation.
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The most important thing to do to protect against silent ischemia is to take action to manage your underlying cardiovascular risks. This includes quitting smoking, achieving and maintaining a healthy weight, exercising regularly, eating well, managing your cholesterol and blood pressure, and getting regular medical check-ups and screenings. You should also take medications such as aspirin, b-blockers, calcium channel blockers, and statins to help lower your blood cholesterol and blood pressure and improve the condition of your arteries.
Treatment for silent ischemia depends on the cause. For example, if the ischemia is caused by a narrowing in your coronary artery, treatment may include lifestyle modifications and medication (such as b-blockers, angiotensin-converting enzyme inhibitors, and statins). If you are unable to control your underlying cardiovascular risks, revascularization (angioplasty or CABG) can be performed.
Silent ischemia is much more common than most people realize, and it can have a serious impact on your health. Fortunately, it is also treatable, and knowing the signs and symptoms can help you stay in good shape and avoid complications. If you think you might have a problem with your heart, contact a Beaumont cardiologist today for more information or to schedule an appointment.
Symptoms
Ischemic heart disease develops when plaque (a combination of fatty material and cells) builds up in the coronary arteries that supply blood to your heart. This prevents parts of your heart from receiving enough oxygen-rich blood and can cause chest pain or discomfort, known as angina pectoris. Over time, if the blockage gets worse, it can lead to heart attack.
When you have ischemic heart disease, your doctor will usually refer you to a specialist called a cardiologist. This doctor will take your medical history and perform a physical exam. The cardiologist may also order a variety of tests to diagnose the condition. These tests will probably include a blood test, an electrocardiogram and an echocardiogram.
These tests will help your doctor determine the severity of your ischemia and what your risk for additional complications is. In addition, the cardiologist will likely recommend lifestyle changes and medications to control your ischemic heart disease and reduce your risk of heart-related problems.
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For example, your doctor will probably recommend that you eat a diet low in fat and cholesterol and exercise regularly. You should also quit smoking and limit your alcohol intake. These habits will improve your blood flow and reduce the likelihood of a heart attack.
In some people, ischemia occurs without any obvious symptoms. This is sometimes called silent ischemia or silent myocardial infarction. Ischemia is more likely to occur during periods of excitement, stress or physical exertion when your heart needs more blood flow than usual. If the lack of blood flow continues for a long time, then some heart muscle cells can die and this is known as myocardial infarction or a heart attack.
You should call 911 or your local emergency number if you have chest pain that doesn’t go away after resting for a while, especially if the pain is accompanied by other symptoms of a heart attack like fainting or vomiting. It’s important to see your doctor as soon as possible so that he or she can unblock the artery and save as many heart muscle cells as possible.
