Ischemic heart disease (heart attack)

Coronary heart disease (CHD), also known as coronary artery disease, ischemic heart disease refers to a narrowing of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Coronary heart disease is the leading cause of death in Ukraine.

What is coronary heart disease?

Coronary arteries are the heart's network of blood vessels. They exist on the surface of the heart, and they supply the heart muscle with oxygen. If the coronary arteries narrow, the supply of oxygen-rich blood to the heart may become too low, especially during physical activity.

Causes

CHD is believed to start with injury or damage to the inner layer of a coronary artery. This damage causes fatty plaque deposits (atheroma) to build up at the site of the injury. These deposits consist of cholesterol and other cellular waste products. The accumulation is called atherosclerosis.

At first, this reduction in blood flow may not produce any symptoms, but as fatty deposits, or plaques, build up in the coronary arteries, signs and symptoms may emerge.

In the time course arteries may become so narrow because of such deposits that they cannot deliver enough oxygen-rich blood to the heart. The pain and discomfort one may feel as a result of this is called angina.

If a piece of atheroma breaks off it may cause a blood clot (blockage) to form. If it blocks the coronary artery and cuts off the supply of oxygen-rich blood to the heart muscle, the heart may become permanently damaged. This is known as a heart attack.

Symptoms

Angina. The following are symptoms of angina:

• Chest pain: People describe it as a squeezing, pressure, heaviness, tightening, burning, or aching across the chest. It usually starts behind the breastbone. The pain often spreads to the neck, jaw, arms, shoulders, throat, back, or even the teeth.
• Related symptoms: Other symptoms include indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath.

There are several main types of angina:

• Stable angina: The discomfort may last for a short period of time, and it may feel like gas or indigestion. It happens when the heart is working harder than usual, such as during exercise. It has a regular pattern. It can happen over months or years. Rest or medication can relieve symptoms.
• Unstable angina: This is often caused by blood clots in the coronary artery. It occurs at rest, it is surprising, it lasts longer, and it may worsen over time.
• Variant angina: This type occurs at rest, and it is usually severe. It happens when there is a spasm in an artery that causes it to tighten and narrow, disrupting blood supply to the heart. Triggers include exposure to cold, stress, medicines, smoking, or cocaine use.

Shortness of breath. CHD can lead to shortness of breath. If the heart and other organs are getting too little oxygen, the patient may start panting. Any exertion may be very tiring.

Heart attack

Heart attack, or myocardial infarction, happens when the heart muscle does not have enough blood, and therefore oxygen. The muscle dies, and a heart attack occurs.

A heart attack commonly occurs when a blood clot develops from a plaque in one of the coronary arteries. The clot, if it is big enough, can stop the supply of blood to the heart. The blood clot is known as coronary thrombosis.

Symptoms of a heart attack include:

• chest discomfort and mild pain, or a crushing chest pain
• coughing
• dizziness
• shortness of breath
• face seems gray
• an overall feeling of being unwell and fear that life is coming to an end
• nausea and vomiting
• restlessness
• perspiration and clammy skin

The first symptom is normally chest pain that spreads to the neck, jaw, ears, arms, and wrists, and possibly the shoulder blades, the back, or the abdomen.

Changing position, resting, or lying down brings no relief. The pain is often constant, but it can come and go. It can last from a few minutes to many hours.

A heart attack is a medical emergency. It can result in death or permanent damage to the heart muscle. If anyone has signs of a heart attack, it is crucial to call the emergency services immediately.

Treatment

CHD cannot be cured, but with today's technology, it can be managed effectively.

Treatment involves lifestyle changes, and possibly some medical procedures and medications.

Lifestyle recommendations include quitting smoking, eating a healthy diet, and exercising regularly.

Medications may include:

• Statins: These are the only medications demonstrated to have a positive impact on outcomes in CHD, but if a person has another underlying cholesterol disorder, they may not work.
• Low-dose aspirin: This reduces blood clotting, lowering the risk of angina or a heart attack.
• Beta blockers: May be used to reduce blood pressure and heart rate, especially in a person who has already had a heart attack.
• Nitroglycerin patches, sprays, or tablets: These control chest pain by reducing the heart's demand for blood by widening the coronary arteries.
• Angiotensin-converting enzyme (ACE) inhibitors: These lower blood pressure and help to slow or stop the progression of CHD.
• Calcium channel blockers: This will widen the coronary arteries, allowing greater blood flow to the heart, and reduce hypertension.

Surgery

Surgery can open or replace blocked arteries, if the blood vessels have become very narrow, or if symptoms are not responding to medications:

• Laser surgery: This involves making several tiny holes in the heart muscle, which encourage the formation of new blood vessels.
• Coronary bypass surgery: The surgeon uses a blood vessel from another part of the body to create a graft that can bypass the blocked artery. The graft may come from the leg or an inner chest-wall artery.
• Angioplasty and stent placement: A catheter is inserted into the narrowed part of the artery. A deflated balloon is passed through the catheter to the affected area. When the balloon is inflated, it compresses the fatty deposits against the artery walls. A stent, or mesh tube, may be left in the artery to help keep it open.

Rarely, a heart transplant may be needed, if the heart is badly damaged and treatment is not working.