Ischaemic Heart Disease

What is it?

• 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.

• Temporary damage and pain (ischemia)
• Most death is due to arrhythmias, usually tachyarrhythmias
• 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 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

• Do not smoke.
• prevent/treat hypertension (high blood pressure)
• Exercise regularly (Exercising the heart muscle strengthens it, like any other)
• Avoid obesity: increasing body fat stores, especially intra-abdominal fat, increases serum cholesterol, triglycerides, insulin requirements and promotes Diabetes Mellitus plus chronicly increases heart muscle workload.
• Avoid excess process modified saturated fats, often called transfats in the diet. Some mono-unsaturated fats are probably beneficial in reducing the risk of heart disease when consumed in moderation. 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.

Treatment of a heart attack.

• Specialised coronary care (the sooner the better); most deaths are due to sudden onset arrhythmias, time is muscle and survival.
• Cardiopulmonary resuscitation (breathing support, pulse and BP monitoring & possible chest compressions).
• A defibrillator can stop cardiac arrhythmias.
• An artificial pacemaker can speed up cardiac bradyarrhythmias.
• Drugs such as adrenaline can increase heart rate and strength of contractions, although also promote tachyarrhythmias.
• Thrombolytic agents can clear away compounding blood clots.
• Anticoagulation can impede additional blood clots.
• Inotropic drugs will raise blood pressure.
• Unblock arteries with angioplasty ("balloon angioplasty with or without stents") or surgery.

After a heart attack

• 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.
• Increase exercise within limits of safety (see prevention) to train the heart.

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