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3.5 Minute

26-07-2024 Team Medicover cardiology

Written by Medicover Team and Medically Reviewed by Dr S Srikar Samir Nandan, Interventional Cardiologist

Ischemic Heart Disease (IHD) : Causes, Symptoms, and Treatment

When there is insufficient blood flow to the heart and the heart muscle does not receive adequate oxygen, the condition known as ischemic heart disease (IHD) develops.

Chest pain or discomfort that recurs can result from it. An ischemic state is one in which a region of the body is not getting enough blood that is rich in oxygen.

Plaque accumulation on the coronary artery walls causes IHD heart disease. The symptoms of IHD heart disease are more common during periods of excitement or physical exertion, but they can occur suddenly and without warning.

Options for heart treatment include medication, dietary changes, and even surgery. The signs, causes, and therapies of IHD heart disease are discussed in this article. Find out how to lower your chance of getting this kind of heart disease by reading on.

What Is Ischemic Heart Disease (IHD)?

Ischemic heart disease (IHD), also known as coronary artery disease (CAD) or coronary heart disease, is a condition where the blood flow to the heart muscle is reduced or blocked due to narrowed or blocked coronary arteries.

This reduced blood flow deprives the heart of oxygen and nutrients, leading to symptoms like chest pain (angina), shortness of breath, or in severe cases, heart attack (myocardial infarction). IHD is a leading cause of death worldwide.

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What Is the Main Cause of Ischemic Heart Disease?

The primary cause of ischemic heart disease is atherosclerosis, a process where plaque (made of fat, cholesterol, calcium, and other substances) builds up in the coronary arteries, narrowing them and restricting blood flow. Key contributing factors include:

High cholesterol levels: Excess low-density lipoprotein (LDL) cholesterol promotes plaque formation.
Hypertension: High blood pressure damages artery walls, accelerating atherosclerosis.
Smoking: Damages blood vessels and reduces oxygen in the blood.
Diabetes: Elevates blood sugar, which can damage arteries over time.
Lifestyle factors: Poor diet, lack of exercise, and obesity increase risk. Genetics and family history also play a role, but atherosclerosis driven by these risk factors is the central mechanism.

What Is Considered Ischemic Heart Disease?

Ischemic heart disease encompasses conditions caused by reduced blood flow to the heart muscle due to coronary artery issues. These include:

Stable angina: Chest pain triggered by physical exertion or stress, relieved by rest or medication like nitroglycerin.
Unstable angina: Sudden, unpredictable chest pain that occurs at rest or with minimal exertion, indicating a higher risk of heart attack.
Myocardial infarction (heart attack): Complete blockage of a coronary artery, causing heart muscle damage due to prolonged lack of oxygen.
Chronic ischemic heart disease: Long-term reduced blood flow leading to heart failure or arrhythmias.
Silent ischemia: Reduced blood flow without noticeable symptoms, often detected through tests like stress testing or electrocardiograms (ECG).

These conditions are diagnosed through tests like ECG, stress tests, coronary angiography, or blood tests for cardiac markers. Treatment may involve lifestyle changes, medications (e.g., statins, beta-blockers), or procedures like angioplasty or bypass surgery.

What Are the Types of Ischemic Heart Disease?

There are four common types of IHD:

Stable Angina – Chest pain that occurs predictably with exertion or stress.
Unstable Angina – Unexpected chest pain that may occur at rest; a medical emergency.
Myocardial Infarction (Heart Attack) – Complete blockage leading to permanent heart damage.
Variant Angina (Prinzmetal's Angina) – Caused by coronary artery spasms, usually at rest.

Do IHD and Coronary Artery Disease Mean the Same Thing?

It's not the same. Though not always, coronary artery disease can lead to IHD heart disease. When blood traveling through the coronary arteries cannot deliver enough oxygen, for instance, the heart may become ischemic.

Heart disease that is not ischemic can nonetheless occur in people with coronary artery disease. For example, the patient may have coronary artery disease despite the presence of plaque, which does not significantly reduce blood flow to the point where an ischemic heart occurs.

Ischemic Heart Disease Symptoms and Treatment

Blood flow via the coronary arteries is reduced in patients with IHD heart disease. Oxygen-rich blood is supplied to the heart muscle via these arteries. If the heart isn't getting enough blood and oxygen, it could cause several symptoms. From person to person, the symptoms may differ. Typical examples include the following:

Pressure, weight, or tightness in the chest that radiates to the back, arms, or other areas
Indigestion or stomach gas
Elevated effort, typically during physical activity

Risk Factors and Indications for Death

IHD heart disease can cause a heart attack. If you encounter any of these severe symptoms, give the doctor or hospital a call. These symptoms include:

Pressure or pain in the chest that typically radiates to the jaw, neck, shoulder, or arm on the left side of the body
Sweaty skin
Vomiting or feeling queasy
Breathing too quickly or too slowly
Vertigo or impending fainting

Ischemic Heart Disease Diagnosis

Diagnosing ischemic heart disease (IHD) involves assessing symptoms, medical history, risk factors, and using specific tests to confirm reduced blood flow to the heart muscle. Below is an overview of the diagnostic process:

1. Medical History and Symptom Assessment

Symptoms: Doctors evaluate symptoms like chest pain (angina), shortness of breath, fatigue, or discomfort in the jaw, neck, arms, or back. They distinguish between stable angina (triggered by exertion) and unstable angina (occurring at rest).
Risk Factors: Family history, smoking, hypertension, high cholesterol, diabetes, obesity, and sedentary lifestyle are reviewed.
Medical History: Prior heart conditions, surgeries, or related illnesses (e.g., diabetes, kidney disease) are considered.

2. Physical Examination

Checking for signs like abnormal heart sounds, high blood pressure, or swelling (edema) that may indicate heart strain or failure.

3. Diagnostic Tests

Several tests confirm IHD by detecting reduced blood flow, heart muscle damage, or coronary artery blockages:

Electrocardiogram (ECG/EKG): Records the heart’s electrical activity to detect abnormal rhythms, ischemia, or prior heart attack damage. Changes like ST-segment depression or T-wave inversion suggest IHD.
Stress Testing:
- Exercise Stress Test: Monitors ECG, heart rate, and blood pressure during physical activity (e.g., treadmill or stationary bike) to detect ischemia triggered by exertion.
- Nuclear Stress Test: Uses radioactive dye to visualize blood flow to the heart during rest and stress, identifying areas with poor perfusion.
- Stress Echocardiogram: Utilises ultrasound to evaluate heart function under stress, identifying abnormal wall motion resulting from ischemia.
Echocardiogram: An ultrasound of the heart to evaluate heart structure, valve function, and areas of reduced movement due to poor blood flow.
Coronary Angiography: A catheter-based test where dye is injected into the coronary arteries, and X-rays show blockages or narrowing. This is the gold standard for confirming coronary artery disease.
Cardiac CT Scan:
- Coronary Calcium Scan: Measures calcium deposits in coronary arteries, indicating atherosclerosis.
- CT Angiography: Visualizes coronary arteries non-invasively to detect blockages.
Blood Tests:
- Cardiac Biomarkers: Elevated levels of troponin or CK-MB indicate heart muscle damage (e.g., heart attack).
- Lipid Profile: Measures cholesterol levels (LDL, HDL, triglycerides) to assess atherosclerosis risk.
- C-reactive Protein (CRP): Indicates inflammation, which may contribute to IHD.
Cardiac MRI: Provides detailed images of heart tissue and blood flow, used in complex cases to assess ischemia or scar tissue.

4. Additional Considerations

Silent Ischemia: In patients without symptoms (e.g., diabetics or elderly), IHD may be detected incidentally through routine ECG or stress tests.
Risk Stratification: Tools like the Framingham Risk Score or ASCVD Risk Calculator estimate the likelihood of IHD based on age, gender, cholesterol, blood pressure, and other factors.

5. Differential Diagnosis

Doctors rule out non-cardiac causes of chest pain (e.g., acid reflux, lung issues, or musculoskeletal pain) or other cardiac conditions (e.g., pericarditis, aortic dissection).

Next Steps After Diagnosis

Lifestyle Changes: Diet, exercise, smoking cessation.
Medications: Statins, antiplatelets (e.g., aspirin), beta-blockers, or nitroglycerin.
Procedures: Angioplasty, stenting, or coronary artery bypass grafting (CABG) for severe cases.
Monitoring: Regular follow-ups are conducted to manage risk factors and prevent disease progression.

Ischemic Heart Disease Treatment (IHD)

Restoring blood flow and lowering the risk of a heart attack are the usual goals of treatment for IHD. Our team-based, individualized approach is how Advocate Health Care's cardiologists and heart surgeons deliver the most recent therapies for it.

Noninvasive Methods for Treating IHD Heart Disease

Non-invasive treatments may help improve blood flow, depending on the severity of your symptoms. To manage this disease and reduce your risk of further complications, your physician may recommend medication or lifestyle modifications.

Medications for Ischemic Cardiomyopathy

Your physician might recommend drugs to:

Reduce cholesterol
Reduce arterial pressure
Address underlying illnesses like diabetes
Lower your chance of thrombosis

Changes in Lifestyle

Your physician might suggest making lifestyle adjustments like:

Maintaining a diet low in fat
Obtaining higher quality rest
Increasing activity
Getting in shape
Reducing anxiety
Engaging in a program for cardiac rehabilitation
Giving up smoking
Cutting back on alcohol use

Procedures to Treat IHD Heart Disease

If medicine alone is not enough to treat your severe symptoms, your doctor may recommend a coronary angioplasty and stent implantation operation or a coronary artery bypass graft (CABG) surgery.

A catheter-based technique called coronary angioplasty and stent implantation is used to clear blockages in the arteries and start the flow of blood again. A procedure called CABG helps the heart pump blood again by directing blood flow through grafted arteries.

How to Prevent Ischemic Heart Disease?

Prevention is crucial. Here are steps to reduce your risk of IHD:

Eat a balanced, low-fat diet
Exercise for at least 30 minutes a day
Avoid tobacco and limit alcohol
Control conditions like diabetes, high blood pressure, and high cholesterol
Get regular checkups and heart screenings if you’re at risk

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What Is the Survival Rate for IHD?

Survival depends on the severity and how early the condition is diagnosed. With proper treatment and lifestyle changes, many people live decades after diagnosis. According to studies, the 5-year survival rate post-heart attack (a common result of IHD) ranges between 70-90%, but it can be lower in those with severe heart damage or additional comorbidities.

Frequently Asked Questions

Life expectancy with IHD varies based on overall health, medical care, and lifestyle. Treatment can extend life, but individual cases differ significantly.

The four stages of ischemic heart disease describe how the condition develops over time. It begins with endothelial dysfunction, where the inner lining of the blood vessels becomes damaged and less effective. This is followed by atherosclerosis, where fatty deposits (plaques) build up in the artery walls. The third stage is plaque rupture or erosion, which can cause sudden narrowing or blockage of the arteries. Finally, thrombosis occurs when a blood clot forms at the site of the rupture, reducing blood flow to the heart and potentially leading to serious heart damage or a heart attack.

Atherosclerosis, or fatty deposits in the coronary arteries, is the leading cause. It decreases blood flow to the heart muscle and increases the risk of heart attacks.

No, ischemic heart disease (IHD) is not the same as cardiac failure, but it can lead to it. IHD occurs when there is reduced blood flow to the heart due to narrowed or blocked coronary arteries. Over time, this can weaken the heart muscle and may result in heart failure—a condition where the heart can’t pump blood effectively. So, while they are different conditions, IHD is one of the leading causes of cardiac (heart) failure.

No, ischemic heart disease (IHD) and myocardial infarction (MI) are not the same, but they are closely related. IHD is a broader condition that refers to reduced blood supply to the heart muscle due to narrowed or blocked arteries. MI, or heart attack, is a serious event that can occur as a result of IHD when the blood flow is completely blocked, causing damage to the heart muscle. In short, MI is one possible outcome or complication of IHD.