Ischemic Heart Disease

What is ischemic heart disease?
Ischemia is caused by either a restriction in blood supply. Ischemic heart disease is characterized by a restriction of blood supply to the heart causing a permanent (myocardial infarction) or temporary malfunction (angina) This decrease is due to constriction or blockage of coronary arteries, through which oxygen and nourishment reach cardiac cells.

Ischemic heart disease describes a spectrum of disease from stable angina, unstable angina, to myocardial infarction, and sudden death.

How common is ischemic heart disease?
Ischemic heart disease is a common condition, not only in the West, but elsewhere, particularly the Indian subcontinent. Factors such as smoking, obesity, diabetes, hypertension and high cholesterol are important causes.
Its incidence will increase; according to the assessments by the World Health Organization, by 2020 it will be the commonest cause of death and disability.

What causes ischaemic heart disease?
Ischemic heart disease is due to the development of atherosclerosis, a degenerative process which involves all the arterial blood vessels but most frequently the coronary arteries. When a thrombus causes a complete occlusion, a myocardial infarct may occur.

How does it evolve?
Coronary atherosclerosis often begins in the early adult life. Its evolution is usually very slow, but can be accelerated by the above mentioned risk factors. When the coronary obstruction becomes severe the first ischemic symptoms apppear. However, in many cases no significant symptoms are manifest: the heart suffers silently.

How is ischemic heart disease diagnosed and how can it be prevented?
A patient with ischemic heart disease must undergo a series of clinical examinations:
- electrocardiogram (ECG): to determine the rhythm and whether there has been previous myocardial infarction.
- exercise stress test: Is often necessary to diagnose the presence of ischemia, and to determine the effort tolerance of the subject and assess risk, and whether the therapy is efficacious..
- myocardial scan: a radioactive substance allows assessment of myocardial perfusion and detect the presence of previous myocardial infarct.
- echocardiography: provides a non-invasive assessment of the muscle function of the heart, and its valves.
- cardiac catheterization: is an invasive procedure to access coronary circulation using a catheter to determine if there are narrowings or occlusions and to decide whether the patient needs an operation, or have a balloon procedure.

Ischemic heart disease prevention is based on the prevention of atherosclerosis, a disease which begins at early age and proceeds with aging. Good habits for prevention are: no smoking, exercise frequently, and a healthy "Mediterranean style" diet.