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Understanding And Treating Ischaemic Heart Disease - A system review

Heart, Men's Health, Age related illnesses, Women's Health | June 23, 2014 | Author: The Super Pharmacist

Heart Attack, heart disease, heart, isch

Understanding And Treating Ischaemic Heart Disease - A system review

Ischaemic heart disease is a leading form of heart failure. It is also known by other names, including coronary myopathy or coronary artery disease. It refers to the reduction of blood flow into cardiac tissue (i.e. the heart), mainly associated with the accumulation of cholesterol plaques (atherosclerosis) on the interior walls of coronary arteries (the vessels that pump blood into the heart muscle itself).

Over time, this may result in a significant decrease in the concentration of oxygen and other molecules to cardiac muscle tissue, without which these tissues cannot function properly. This may culminate in the death of heart tissue due to starvation of nutrients and energy.

Therefore, ischaemic heart disease may have severe consequences for the overall health of patients affected. This condition is thought to be a leading cause of death worldwide. Recent estimates indicate that this condition is responsible for up to 46% of all deaths caused by cardiovascular disease (CVD) in men, and up to 38% of these deaths in women. CVD is associated with approximately 30% of all preventable death worldwide.

Risk Factors for Ischaemic Heart Disease

Ischaemic heart disease is associated with many risk factors. The most prevalent include:

  • hypercholesterolemia (i.e. a high cholesterol level),
  • hypertension (high blood pressure),
  • hyperlipidaemia (a high level of fat molecules in the blood)
  • and type II diabetes

Genetic factors may also contribute to the risk of ischaemic heart disease; for example, the condition is associated with individuals who tend to produce high levels of certain blood proteins and other molecules. These include fibrinogen and C-reactive protein.

Risk Factors for Ischaemic Heart DiseaseLifestyle factors. Ischaemic heart disease may be linked to certain lifestyle factors, such as smoking, reduced daily exercise and a regular intake of certain fats.

Health conditions. It is also indirectly linked with certain conditions (e.g. obesity) that are also associated with major risk factors.

Unknown factors.
There are also cases of this condition to which none of these factors apply, and/or in which atherosclerosis is not detected. This is known as idiopathic heart disease, or cardiac syndrome X11.

Symptoms of Ischaemic Heart Disease

The symptoms of ischaemic heart disease are often chronic, and are also acute indications of a heart attack, or large-scale failure of cardiac muscle. These include angina pectoris, or discomfort and pain in the chest area. Angina pectoris may indicate 'stable' ischaemic heart disease, i.e. cases where arterial narrowing is present, but without immediate danger of heart attack, and the condition is manageable with treatment (see below).

More sudden-onset chest pains are also a sign of a heart attack, or the death of cardiac tissue. An acute and life-threatening dysfunction of cardiac muscle is often termed a heart attack or acute myocardial infarction. This is often accompanied by significant difficulty in breathing, fatigue, sweating and nausea.

Diagnosing Ischaemic Heart Disease

Diagnosis of ischaemic heart disease may be achieved by one or more direct imaging techniques, such as magnetic resonance imaging (MRI), angiography, near-infrared spectroscopy, intravascular ultrasound or echocardiography.

It may also be detected by comparing an electrocardiogram (ECG) (non-invasive readings of heart activity translated to a graph) while the patient undergoes experimental stress (such as exercise) with a baseline or resting ECG.

Ischaemic heart disease detection under emergency circumstances (i.e. heart attack) may include emergency angiography or surgical interventions to visualise or treat the myocardial failure.
 

Ischaemic heart disease may also persist without noticeable symptoms ('silent ischaemic heart disease') which may culminate in an unexpected acute event such as a heart attack.

Treatment for Ischaemic Heart Disease

Treatments for ischaemic heart disease may be administered in response to the diagnosis of the condition (i.e. to an individual with a 'stable' form of the disease), in the course of acute heart failure or after an acute incident. These treatments are mainly pharmaceutical in nature.

Pharmaceutical Therapies

Organic nitrates are a class of drugs that act through their relaxing effect on smooth muscle, which is found in arteries. The rationale is that this will contribute to increased arterial dilation ('vasodilation'), and thus reduce blood flow constriction in arteries affected by stenosis or atherosclerosis. Organic nitrates include:

  • isosorbate dinitrate (ISDN)
  • isosorbate mononitrate

These drugs may treat stable ischaemic heart disease and hypertension. They may also be administered following an acute attack in combination with some other vasodilators; hydralazine and ISDN are a particularly effective example of this. Organic nitrates act by breaking down into nitric oxide (NO) in the body, which stimulates the relaxation of smooth muscle. It was thought that the closely-related molecule nitroglycerine works in the same matter. However, recent research indicates that this classic heart disease treatment may activate the enzyme nitric oxide synthase (which converts other compounds to NO) instead. Beta-blockers are another popular treatment for ischaemic heart disease. These inhibit the action of the neurotransmitters noradrenaline and adrenaline, which mainly act to increase cardiac muscle movement and oxygen use. Therefore, these drugs reduce the demand for oxygen and other molecules, and may contribute in this way to moderate muscle cell death due to nutrient starvation. Beta-blockers include:

  • Timolol 
  • Atenolol 
  • Propranolol

The latter is counterindicated if nitrates are also administered, as this may cause excessive hypotension36. These drops in blood pressure are in themselves a potentially harmful condition. Other drugs used to treat ischaemic heart disease act to reduce cholesterol formation in the body, so as to prevent plaque formation within coronary arteries. The most prevalent of these would be the statins. This class of drugs inhibit the first step of the conversion of dietary fats (triglycerides) to cholesterol. Fibrates reduce the concentration of triglycerides in the blood, while ezetimibe reduces dietary cholesterol absorption from the intestines.

Surgery

Treatments for this condition also include surgery, as mentioned above. These invasive interventions include:

Coronary artery bypass graft (also popularly known simply as a 'bypass'), in which a length of another artery is autografted (i.e. taken from the patient in question) onto the coronary vascular system to take over the functions of a blocked artery.

Angioplasty, in which coronary arteries are opened or unblocked. This may be achieved through the implantation of a stent. This is a hollow tube which is placed in an affected artery in order to keep it open.

These interventions may be a part of emergency treatment, or carried out to prevent an acute cardiac event.

Lifestyle Changes

The role of behaviour or lifestyle modifications in preventing or treating ischaemic heart disease has also been recognised in the last few years.

These can include:

  • Reduction or cessation of smoking.
  • Increase in regular exercise.
  • Some B-vitamins are also associated with a reduction of arterial plaque and the reduced risk of CVD in general. Therefore, an increased intake of foods rich in these may reduce the risk or progression of ischaemic heart disease.
  • Certain foods are also rich in nitrates (i.e. molecules similar to ISDN), which have been shown to be beneficial to cardiovascular health.
  • Vitamin D may contribute to the treatment or prevention of cardiac syndrome X11.
  • Rehabilitative exercise is also a possible component of heart failure recovery.

In conclusion, ischaemic heart disease is a common cause of preventable death, the risk of which may be ameliorated by maintaining a healthy lifestyle and diet. Treatment for this condition is well-researched and developed.

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