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 , usually present even when the
Artery Lumen s appear normal by
Angiography , see
IVUS .
- Initially there is sudden severe narrowing or closure of either the large Coronary Arteries and/or of Coronary Artery end branches by debris showering downstream in the flowing blood. It is usually felt as Angina , especially if a large area is affected.
- The narrowing or closure is predominantly caused by the covering of Atheromatous plaques within the wall of the artery rupturing, in turn leading to a Heart Attack (Heart attacks caused by just artery narrowing are rare).
- A heart attack causes damage to heart muscle by cutting off its blood supply.
This can cause:
- Temporary damage and pain ( Ischemia )
- Loss of muscle activity (acute heart failure)
- Permanent heart muscle damage, heart muscle does not grow back (acute myocardial infarction /infarct)
- Long term loss of heart muscle activity (chronic Heart Failure )
- Cardiac Arrhythmia s: irregular heartbeat which can be fatal. Most death is due to arrhythmias, usually tachyarrhythmias.
- Other structural damage to the heart including damaged Heart Valve s, actual perforation of the heart and a thin walled fibrous floppy heart.
Prevent or delay atherosclerosis.
- Do not Smoke .
- prevent/treat Hypertension (high blood pressure)
- Exercise regularly (Exercising the heart muscle strengthens it, like any other)
- Avoid fat, increases serum Cholesterol , Triglyceride s, Insulin requirements and promotes Diabetes Mellitus plus chronically increases Heart Muscle workload.
- Avoid consumption of trans-fatty acids. These are found in any chemically modified fat product, such as margarine, in hydrogenated fats, and especially in superheated fats (such as those used for commercial deep frying). These fats are toxic and should not be consumed in any amount; however, in many western countries, limitation may be the only practical option. Some mono-unsaturated fats are beneficial in reducing the risk of heart disease when consumed in moderation. When consumed in excess, however, other health concerns arise. An increase in polyunsaturated fats is also warranted in most American diets. Dietary cholesterol intake is known to have only limited effect on serum cholesterol.
- Take LDLipoprotein Cholesterol reducing and HDLipoprotein raising drugs and verfiy both LDLipoprotein particle counts and quantitative large HDLipoprotein response to treatment.
- Avoiding Shift Work .
The option required depends on the situation.
- Possible angioplasty or cardiac surgery.
- Possibly the regular administration of anti-coagulants to prevent further blood clot complications.
- Possibly the administration of drugs to reduce heart arrhythmias although they many also induce arrhythmias.
- Lifestyle modifications are important in prevention of a second MI; increased exercise, reduction of stress, and improved dietary considerations are perhaps most important
