Ischaemic heart disease

Ischaemic heart disease is a disease characterized by reduced blood supply to the heart. It is the most common cause of death in most western countries.

Ischaemia means a "reduced blood supply". The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries reduces the supply of blood to heart muscle.

Most ischaemic heart disease is caused by atherosclerosis.

What is it?

  • Initially there is narrowing of coronary arteries causing angina.
  • The narrowing is mostly caused by fatty plaques lining the wall of the artery.
  • Sometimes a fatty plaque will rupture leading to a heart attack. (Heart attacks caused by simple narrowing are relatively uncommon).
  • A heart attack causes damage to heart muscle by cutting off its blood supply.

This can cause:
  • Temporary damage and pain (ischaemia)
  • Loss of muscle activity (acute heart failure)
  • Permanent heart muscle damage (acute myocardial infarction /infarct)
  • Long term loss of heart muscle activity (chronic heart failure)
  • Cardiac arrhythmias: irregular heartbeat which can be fatal.
  • Other structural damage to the heart including damaged heart valves, actual perforation of the heart and a thin walled fibrous floppy heart.

Prevention. Prevent or delay atherosclerosis.
  • Do not smoke.
  • Treat hypertension (high blood pressure)
  • Exercise regularly (Exercising the heart muscle strengthens it, like any other)
  • Avoid obesity: a large body puts unnecessary strain on the heart and increases serum cholesterol and triglycerides.
  • Avoid excess saturated fat in the diet. Some unsaturated fats may be beneficial in reducing the risk of heart disease when consumed in moderation. Dietary cholesterol is shown to have a modest effect on serum cholesterol.
  • Take cholesterol reducing drugs.

Treatment of a heart attack. Which of these options are required depends on the situation.

  • Specialised coronary care (the sooner the better).
  • Cardiopulmonary resuscitation (heart massage).
  • A defibrillator can revert cardiac arrhythmias.
  • An artificial pacemaker can prevent cardiac arrhythmias.
  • Drugs such as adrenaline can increase heart rate.
  • Thrombolytic agents can clear away the causative blood clot.
  • Anticoagulation can prevent additional blood clots.
  • Inotropic drugs will raise blood pressure.
  • Unblock arteries with surgery or angioplasty ("balloon angioplasty")

After a heart attack
  • Possible cardiac surgery.
  • Possibly the regular administration of anti-coagulants to prevent further arrhythmias
  • Possibly the regular administration of drugs to control heart rhythm.
  • Increase exercise within limits of safety (see prevention) to train the heart.



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