Ischemic heart disease

Ischemic heart disease is the disease caused by an imbalance between the supply and demand of oxygen to the heart and this is due in more than 90% to atherosclerosis of the coronary arteries, (those responsible for providing blood to the heart muscle (myocardium) ). Coronary atherosclerosis is a slow process of collagen formation and accumulation of lipids (fats) and inflammatory cells (lymphocytes). These three causes cause narrowing (stenosis) of the coronary arteries.

This process begins in the first decades of life, but does not present symptoms until the coronary artery stenosis becomes so severe that it causes an imbalance between the supply of oxygen to the myocardium and its needs. In this case, a myocardial ischemia (stable angina pectoris) or a sudden occlusion due to thrombosis of the artery occurs, which causes a lack of oxygenation of the myocardium resulting in acute coronary syndrome (unstable angina and acute myocardial infarction).

Summary

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  • 1 Causes
  • 2 Symptoms
  • 3 Diagnosis
  • 4 Forecast
  • 5 Treatment
  • 6 External links
  • 7 Sources

Causes

Ischemic heart disease is a disease that can be significantly prevented if its cardiovascular risk factors are known and controlled. The main ones are:

  1. More prevalence in older people.
  2. It occurs more in men, although the frequency in women is equalized after menopause.
  3. Family history of premature ischemic heart disease.
  4. Increase in total cholesterol levels, especially LDL (bad).
  5. Decreased HDL cholesterol values ​​(good).
  6. Smoking .
  7. Hypertension .
  8. Diabetes mellitus .
  9. Obesity .
  10. Sedentary lifestyle.

Patients with multiple risk factors have the highest risk of suffering obstructive coronary artery disease, and therefore, the greatest possibility of angina or heart attack. The danger is even greater in people with the so-called metabolic syndrome, that is, the association of obesity, diabetes, increased cholesterol and hypertension.

Symptoms

Stable angina pectoris is a symptom of recurrent chest pain due to myocardial ischemia. Those who have suffered it define it with terms such as oppression, tightness, burning or swelling. It is located in the area of ​​the sternum, although it can be displaced to the left jaw, throat, shoulder, back, and arm or wrist. It usually lasts between 1 and 15 minutes.

Angina pain is triggered after physical exercise or emotions and is relieved in a few minutes with rest or sublinlingual nitroglycerin. It usually worsens in circumstances such as anemia, uncontrolled hypertension, and fever. Also, cold weather, cigarette smoking, humidity, or a large meal can increase the intensity and frequency of anginal episodes.

Diagnosis

It is mainly carried out due to clinical suspicion of chest pain, although complementary tests are not ruled out if other atypical symptoms appear. In addition, patients with suspected stable angina pectoris undergo an electrocardiogram.

The stress test or ergometry is the most used test to obtain tests

Heart affected by ischemic heart disease.

objectives of myocardial ischemia and prognostic information of patients with angina. The patient performs continuous exercise on a treadmill or ergometric bicycle to assess his clinical response (if there is pain during exercise) and his electrical response (if there are changes in the electrocardiogram during exertion that suggest myocardial ischemia). This test is not evaluable if there are baseline abnormalities of the electrocardiogram or if the patient is taking certain drugs (for example, digoxin). Obviously, an ergometry cannot be performed if the patient has a locomotor problem that prevents him from walking correctly. In these cases, stress tests are done with drugs (dobutamine) or radioisotopes.

Coronary arteriography (coronary angiography or catheterization) is the gold standard for exact diagnosis, although it is an invasive and moderately expensive test. In general, it is only performed if the results of the previous tests are conclusive for significant coronary disease and with poor prognosis data. It is also used in patients with atypical symptoms when non-invasive tests are inconclusive.

Forecast

The prognosis is highly variable, since it depends on the extent of the disease and how the heart muscle has been damaged by it. There are patients who can be controlled without practically presenting symptoms to others who have a very short life expectancy. The factors that most influence the prognosis are the good or bad control of coronary risk factors.

Treatment

Patients with angina pectoris should strictly control cardiovascular risk factors and follow regular controls to prevent the appearance of new ones. And if they exist, they must be corrected:

  • Give up the bad habit of smoking or smoking.
  • Control hypertension and diabetes .
  • Follow a diet low in cholesterol and fat .
  • Achieve an ideal body weight.
  • Avoid sedentary lifestyle by doing physical exercise.
  • Reduce cholesterol until LDL is less than 100 mg / dl. Even in some cases less than 70 mg / dl.

Regarding pharmacological treatment, except in contraindications, all patients with coronary heart disease should take Acetyl Salicylic Acid (there are many commercial preparations, but the best known is Aspirin) chronically, daily and at low doses (100 – 150 mg ) due to its antiplatelet effect. During periods of instability, they are generally caused by the appearance of clots in places where there are injuries. In these situations, association with other antiplatelets and anticoagulants is usually necessary for a limited period of time.

Nitrates (oral, sublingual, or transdermal patches), beta-blockers, and calcium antagonists are recommended to improve symptoms. Patients with frequent angina attacks undergo treatment of various drugs combined.

Some patients with angina are candidates for coronary revascularization treatments, which can be performed by cardiac bypass surgery (bypass) or coronary angioplasty (with catheterization). The choice between one or the other depends on the characteristics of the disease:

  • This is chosen if the symptoms limit the patient’s quality of life or if non-invasive tests have indicated the existence of severe myocardial ischemia.
  • Coronary angioplasty. It is performed when coronary heart disease allows this technique. A catheter is inserted into the coronary artery and balloon dilated. A stent (metal device such as a cylindrical mesh) is then implanted into the artery to achieve patency whenever possible.
  • For patients with more diffuse coronary disease, when angioplasty is not possible and especially if there is poor function of the left ventricle. It is performed with chest opening and general anesthesia.

 

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