Ischemic Heart Disease

Coronary heart disease (CHD), also known as ‘ischemic heart disease’, is the most common form of heart disease. There are two major clinical forms – heart attack (often known as ‘acute myocardial infarction’ or AMI) and angina. Coronary heart disease is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of your arteries can become clogged up with fatty deposits. This process is known as ‘atherosclerosis’ and the fatty deposits are called ‘atheroma’.

Causes of coronary heart disease Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the coronary arteries. The fatty deposits, called ‘atheroma’, are made up of cholesterol and other waste substances. The build-up of atheroma on the walls of the coronary arteries makes the arteries narrower and restricts the flow of blood to the heart. This process is called ‘atherosclerosis’. Atherosclerosis can be caused by lifestyle habits and other conditions such as: smoking high cholesterol high blood pressure (hypertension) diabetes.

If your doctor thinks you are at risk of CHD, they may carry out a risk assessment. This involves asking about your medical and family history, asking about your lifestyle and requesting a blood test. Symptoms of coronary heart disease If your coronary arteries become partially blocked, it can cause chest pain (angina). If they become completely blocked, it can cause a heart attack (myocardial infarction). Some people experience different symptoms, including palpitations and unusual breathlessness. In some cases, people may not have symptoms of coronary heart disease at all before they are diagnosed.

Angina Angina is chest pain or discomfort caused by insufficient blood flow and oxygen to the muscle of the heart. In most cases the lack of blood flow is due to a narrowing of the coronary arteries. Angina isn’t a disease; it’s a symptom of an underlying heart problem, coronary heart disease (CHD), also called ‘coronary artery disease’. Angina usually occurs during exertion, severe emotional stress or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver.

Angina attacks can be prompted by exertion or physical exercise, when the hardworking heart muscle requires greater amounts of oxygen. The pain usually fades away with rest. Pain and discomfort are the main symptoms of angina which is described as pressure, squeezing, burning or tightness in the chest. The pain may feel like indigestion. Some people say that angina pain is hard to describe or they can’t tell exactly where the pain is coming from.

The most common symptoms of angina can include: pain or discomfort in the middle of the chest pain may be accompanied by breathlessness and sweating pressure or a feeling of tightness in the chest radiating pain to the neck, jaw and left arm, or both arms sometimes, radiating pain in the upper back and shoulders. Signs and symptoms such as nausea, fatigue, dizziness, light-headedness, or weakness also may occur. Angina is often triggered by physical activity or stressful situations. The symptoms usually pass in less than 10 minutes and can be relieved by resting or using a nitrate tablet or spray.

Heart attacks Heart attacks can cause permanent damage to the heart muscle and, if not treated straight away, can be fatal. If you think you are having a heart attack, dial triple zero (000) for immediate medical assistance. The discomfort or pain of a heart attack is similar to that of angina, but it is often more severe. The symptoms of a heart attack can be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn. Or you may experience minimal or no pain. A heart attack can happen at any time, including while you are resting.

Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray. Heart failure Heart failure can occur in people with CHD. The heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or gradually, over time (chronic heart failure). Diagnosis of coronary heart disease Your doctor will ask about your medical and family history, check your blood pressure and do a blood test to assess your cholesterol level.

Your doctor will also ask about your lifestyle, how much exercise you do and whether you smoke. All these factors will be considered as part of the diagnosis. Many people don’t know they have coronary heart disease (CHD) until they have angina or a heart attack. However, if your doctor thinks you are at risk of developing CHD, they may arrange a number of tests (see below) to check your heart health and determine what treatments you may need. Electrocardiogram (ECG) and/or ‘stress ECG’ During an ECG test, electrical leads are placed on your chest, arms and legs.

These leads detect small electrical signals and produce a tracing on graph paper that illustrate the electrical impulses travelling through the heart muscle. Sometimes, an additional ECG test is done while you are exercising on an exercise bike or treadmill. This is known as an ‘exercise ECG’ or ‘stress ECG’ (also called a ‘stress test’). Echocardiogram An echocardiogram uses ultrasound waves to produce a picture of your heart as it beats. This lets your doctor see the structure of your heart and how well it is working. Angiogram This is a special X-ray that shows whether or not your coronary arteries are narrowed or blocked.

Under a local anaesthetic, a small tube (catheter) is inserted into an artery in your arm or groin and guided into the heart. Dye is injected through the catheter into the coronary arteries and X-rays are taken. The X-rays give detailed information about the condition of these arteries. Treatments for coronary heart disease There is no cure for coronary heart disease. However, if you have coronary heart disease (CHD), there are a range of treatments your doctor might recommend to reduce your risk of future heart problems, and relieve or manage symptoms.

Medicines There is now a wide range of medicines to treat CHD and its risk factors, such as high blood pressure and high total blood cholesterol levels. Common medicines (or classes of medicines) include: low-dose aspirin – may be prescribed for you by your doctor unless there are reasons not to, for example if you have a bleeding disorder. This type of medicine will help prevent your blood clotting and can help to reduce your risk of heart attack and angina anti-anginal medications (nitrates) – are used to dilate your blood vessels. Doctors sometimes refer to nitrates as ‘vasodilators’.

They are available in a variety of forms, including tablets, sprays, skin patches and ointments ACE inhibitors – are commonly used to treat high blood pressure beta-blockers – are often used to prevent angina and treat high blood pressure. They work by blocking the effects of a particular hormone in the body and this slows down your heartbeat and improves blood flow statins – if you have a high blood cholesterol level, cholesterol-lowering medicine called ‘statins’ may be prescribed clopidogrel – is used to inhibit blood clotting warfarin – is used as a blood thinning agent that reduces the formation of blood clots.

Taking these medicines as prescribed can greatly reduce your risk of further heart problems. Remember: Most medicines will need to be taken for the long term. You can learn more about medicines for heart problems at www. heartfoundation. org. au Angioplasty and stent implantation After angioplasty is performed, a special expandable metal tube (a ‘stent’) is usually put into your artery, expanded, and left in place to keep your artery open.

Bypass surgery Coronary artery bypass graft surgery (often shortened to CABG and pronounced ‘cabbage’) is an operation in which a blood vessel is taken from your chest, leg or forearm and grafted to your coronary artery to let blood ‘detour’ past a narrowing in this artery. This improves blood flow to your heart muscle and reduces angina. Implantable cardiac defibrillators (ICD) An ICD is a small device that can be put into your chest and connected to your heart to monitor and correct your heartbeat.

It can either stop an arrhythmia (abnormal heart rhythm) by pacing your heart, or in more serious situations, it can give your heart a controlled electric shock to try to return it to its normal rhythm. ICDs can also support your heartbeat like a pacemaker if it is beating very slowly, and collect and store information about your heart’s electrical activity for your doctor to check. Prevention of coronary heart disease Although there is no cure for coronary heart disease, modern treatments and healthy lifestyle choices can greatly reduce your risk of further heart problems and relieve or control symptoms.

To reduce your risk and aid your recovery: take your medicines as prescribed be smoke-free enjoy healthy eating be physically active control your blood pressure and cholesterol achieve and maintain a healthy body weight maintain your psychological and social health. If you have diabetes, you should generally aim to keep your blood glucose levels within the normal non-diabetic range and follow individual advice from your doctor or accredited diabetes educator.

Managing my heart health ‘Managing my heart health’ is an interactive resource for people with, or at high risk of, coronary heart disease. It aims to help you improve your heart health and reduce your risk of further heart problems. It includes: tools to help you achieve your important heart health goals vital information on heart health-related lifestyle, medical and psychological issues. ‘Managing my heart health’ also contains action plans, a medicines card and a handy record card (‘Managing my heart health. At a glance’) to help you and your health professional track your progress.

To order your free single copy, call our Health Information Service on 1300 36 27 87 or email heartline@heartfoundation. org. au Cardiac rehabilitation These programs help you to make practical, potentially life-saving changes to the way in which you live. They can help you and your family deal with physical, emotional, psychological, marital, sexual and work-related issues. The right rehabilitation program will help most people to reduce their risk of further heart problems. Cardiac rehabilitation programs complement the advice that your doctor and/or cardiologist gives you.

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