Ischaemic Heart Disease (IHD): Causes, Symptoms, Treatment

Ischaemic Heart Disease (IHD): Causes, Symptoms, Treatment

Ischaemic Heart Disease (IHD), often called Coronary Artery Disease (CAD), is the world’s leading cause of death. It occurs when the heart’s blood supply is restricted by narrowed or blocked coronary arteries, preventing the heart muscle from receiving the oxygen it needs to function.

In this guide, we break down the 10 essential facts about IHD, from early warning signs to life-saving treatments.

1. What Exactly is IHD?

IHD is an umbrella term for conditions where blood flow to the heart is impaired. When the heart’s “fuel lines” (coronary arteries) become clogged, it leads to myocardial ischaemia. This can manifest in three main ways:

• Angina: Chest pain during exertion.

• Myocardial Infarction (Heart Attack): A sudden, complete blockage.

• Heart Failure: Long-term damage that weakens the heart’s pumping power.

2. Epidemiology: A Global Health Challenge

• The #1 Killer: IHD accounts for approximately 16% of all deaths worldwide.

• Demographics: While it is more common in men under 70, the risk for women increases significantly post-menopause.

• Age Factor: While rare under 40, it is a leading health concern for those over 65.

3. The Primary Cause: Atherosclerosis

The most common cause of IHD is atherosclerosis. This is a process where “plaques” made of cholesterol, fat, and calcium build up on the inner walls of the arteries.

• The “Pipe” Analogy: Imagine a water pipe getting clogged with lime scale; eventually, the water (blood) can’t get through, especially when you turn the tap on full (exercise).

• Less Common Causes: Coronary artery spasms, dissections, or sudden blood clots (thromboembolism).

4. Identifying Risk Factors

We categorize risk factors into two groups: those you can change and those you cannot.

5. Symptoms: Recognising the Warning Signs

Symptoms range from “stable” discomfort to “acute” emergencies.

Angina vs. Heart Attack (MI)

• Stable Angina: Tightness or “squeezing” in the chest that starts during exercise and disappears with rest or nitrate spray.

• Heart Attack (MI): Severe, crushing pain that does not go away with rest. It is often accompanied by sweating, nausea, and pain radiating to the left arm, jaw, or back.

💡 Note: Shortness of breath or extreme fatigue can sometimes be the only symptom of IHD, particularly in women and people with diabetes.

6. Diagnosis: How Doctors Test Your Heart

Diagnosis moves from simple bedside tests to advanced imaging:

• ECG (Electrocardiogram): Records the heart’s electrical activity to check for rhythm issues or signs of a previous attack.

• Blood Tests (Troponin): Detects specific proteins released into the blood when the heart muscle is damaged.

• Echocardiogram: An ultrasound to see how well the heart valves and muscles are moving.

• Coronary Angiography: The gold standard—a dye is injected into the arteries to map out exactly where the blockages are.

7. Differential Diagnosis: Is it My Heart?

Not all chest pain is a heart attack. Doctors must rule out other conditions such as:

• GORD: Acid reflux or heartburn.

• Costochondritis: Inflammation of the rib cage cartilage.

• Pulmonary Embolism: A blood clot in the lungs.

• Anxiety: Panic attacks can mimic heart attack symptoms.

8. Treatment: Managing and Reversing the Damage

Treatment focuses on “revascularization” (opening the pipes) and protecting the heart.

• Medications: Statins (for cholesterol), Beta-blockers (to slow the heart rate), and Antiplatelets (like Aspirin to prevent clots).

• PCI (Angioplasty): A balloon and a metal mesh stent are used to prop the artery open.

• CABG (Bypass): Major surgery where a healthy vessel from the leg or chest is used to “bypass” the blockage.

9. Complications and Long-term Outlook

Untreated IHD can lead to:

• Heart Failure: The heart becomes too weak to pump blood effectively.

• Arrhythmias: Abnormal heart rhythms like Atrial Fibrillation.

• Sudden Cardiac Death: Usually caused by a sudden electrical malfunction.

10. Prevention: Your Best Defence

Primary Prevention is about stopping IHD before it starts via a Mediterranean-style diet and 150 minutes of weekly exercise. Secondary Prevention focuses on strict medication adherence for those already diagnosed to prevent a second event.

Summary

IHD is a manageable, and often preventable, condition. Early detection of high blood pressure and cholesterol is key to avoiding the progression to a heart attack.