Ischemic heart disease: Causes and symptoms of coronary heart disease?

Ischemic heart disease, also abbreviated as coronary heart disease, is a disease that includes several disease states.

It is divided into two main forms.

And it is acute or chronic. They risk damaging a part of the heart that may be irreversible or reversible.

CHD is the leading cause of death worldwide, especially in developed countries.

Irreversible, or irreversible, damage occurs, for example, in an acute heart muscle infarction, which results in the death of a certain part of the heart muscle. This also causes a malfunction.

Therefore, quick response to difficulties and timely professional treatment are important.

You are often interested in: 
What is ischemic / coronary heart disease? 
What forms are they divided into? 
What are its causes and how does it manifest itself? 
What is its prevention, treatment and will a change in diet help? 

Reversible, ie reversible changes and also difficulties arise in angina pectoris. It can have a stable or unstable form. The result is a partial and short-term circulatory disorder of a certain area of ​​the heart that is supplied by the affected coronary artery.

Interesting information:  Also read the articles Acute heart attack and angina pectoris .

The essence of coronary heart disease is therefore insufficient blood flow to the heart muscle, ie ischemia.

Ischemia can be described as a state of imbalance - the disparity between the need and the supply of oxygen to a particular tissue. In cardiac ischemia, it is insufficient blood flow to the heart muscle, myocardium.

CHD = coronary heart disease.

The cause of non-bleeding is mainly the disease process of deposition of certain substances in the vascular wall , known as atherosclerosis . These substances include mainly fats (lipoproteins), but also white blood cells, platelets, and other components of the blood.

Atherosclerotic plaques form in the vessel walls, the inner diameter of the vessel decreases, and this negatively affects the blood flow in the vessels.

Another mechanism of cardiac muscle failure is due to spasm, ie narrowing of the coronary vessels.

As is the case with cocaine.

Other examples include coronary artery embolism, aortic aneurysm dissection, cardiovascular inflammation - Kawasaki disease,  or some congenital coronary artery defects.

The table lists acute and chronic forms of coronary heart disease

The cause of cardiac ischemia lies in the disproportion between the need and the supply of oxygen to the heart muscle, ie the myocardium.

In the vast majority, approximately 90% of cases, the underlying disease is coronary artery disease.

Myocardial ischemia can be caused by the following reasons:

• increased need for oxygen to the heart muscle during exercise
  • the burden is  tachycardia
  • it can be physical
  • but also mental, such as emotional upset, stress, quarrel
• reduced oxygen content in the blood
  • congenital heart defects
  • lung disease
  • severe anemia
  • CO, CO ₂ poisoning
  • hypotension
  • shock, such as anaphylactic shock
• decreased blood flow through a narrowed coronary artery
  • atherosclerosis
  • artery spasm
  • coronary artery inflammation

Atherosclerosis is the most common cause of decreased blood flow through the coronary arteries (arteries). It causes a narrowing of the lumen of the vessel, which is the inner diameter. Blood flows in a way that is impaired in this way.

The condition of the heart's increased demand for oxygen and nutrients is especially problematic. How is it during exertion?

Physical or even mental stress increases heart activity, frequency, and thus the demand for blood supply to the heart muscle.

If this demand is unsatisfied, ischemia occurs. This can manifest as chest pain. This pain is also referred to as angina pectoris.

In atherosclerosis, two types of atherosclerotic plaques can occur, namely:

1. a stable fibromuscular plate that has a firm fibromuscular cap and low fat
   • it increases over time
   • is less prone to complications
   • cause of chronic coronary heart disease or stable angina pectoris (SAP)
2. unstable lipid plate, which has a weak cap with an excess of fat, slurry
   • is risky for complications
   • mostly sudden changes
   • A common complication is ACS (IM or unstable angina pectoris, or NAP)

Atherosclerotic plaques reduce the internal cross-section of the coronary artery. The hemodynamic changes are created by the plaque, which occupies 40% or more of the lumen of the vessel.

Serious hemodynamic problems are created by the plaque, which closes 60-70% of the lumen (inner diameter) of the vessel.

TIP: Read Atherosclerosis at the Medical Center .

Various risk factors are involved in the development of coronary heart disease, such as:

• high blood pressure (arterial hypertension)
• disorders of fat metabolism, dyslipidemia
• diabetes mellitus
• obesity
• smoking
• alcoholism
• reduced level of physical activity, sedentary lifestyle
• improper diet and lack of vegetables and fruits in the diet
• bad lifestyle
• excessive stress
• older age
• male
• family occurrence, heredity
• genetic predisposition

The causes of coronary heart disease are summarized in the table

What symptoms occur in coronary heart disease also depends on its form. And therefore whether it is acute or chronic.

Even, in some cases, nemo occurs, that is, without any symptoms.

The site of narrowing of the heart vessels also affects the overall ischemia, and thus the difficulties present. Secondly, it is the extent of the affected area, which also depends on the extent of coronary artery occlusion. Subsequently, the course is also affected by the current state of the heart and collateral circulation, ie the state of the surrounding vascular network.

The symptoms of CHD are affected by the following factors:

1. the site of closure, and thus the area of ​​the affected heart
2. the extent of vessel occlusion
3. current myocardial status
4. collateral circulation
5. the duration of the closure or flow restriction
6. myocardial load

In most cases, the first symptoms of coronary heart disease occur with increased load. Exercise can be physical or mental. At this point, the body's demands for blood supply, ie blood flow, are escalating. The heart accelerates its activity, heart activity rises and tachycardia begins.

The heart, ie its muscles, tissues, cells (cardiomyocytes) also need more blood flow for this excessive exertion, and thus a sufficient supply of oxygen and nutrients, as well as the outflow of metabolic products. If the requirement is not met, difficulties arise.

In most cases, these acute difficulties subside in peace, after interruption of activity, or satisfaction after mental exertion. If symptoms persist, a heart attack or unstable angina pectoris should be considered. In any case, it is important to seek professional help immediately.

The following symptoms may occur with ischemic heart disease:

• shortness of breath
• fatigue
• inefficiency
• chest pain (pressure, burning, tightness, the feeling of heaviness, discomfort - as an indeterminate feeling)
  • that is, angina pectoris
  • angina pectoris - SAP or NAP
  • it is also referred to as a painful form of coronary heart disease
• pain radiating to the shoulders, neck, upper limb, between the shoulder blades, sledge, and jaw
• pain in the upper abdomen, under the sternum (in the epigastrium)
• nausea
• feeling sick (nausea) to vomiting (vomiting)
• short-term loss of consciousness, ie collapse, syncope
• fainting
• sweating, cold sweat
• pallor
• swelling
• heart rhythm disorders
• heart failure  to cardiogenic shock
• anxiety
• sudden diarrhea

See also: General information on shock - shock .

Myocardial ischemia can only be short-term or transient.
Difficulties recur or are permanent.
Also, the intensity of difficulties can be mild, on the contrary, very strong.

Damage to the heart muscle can be small,  so-called microischemia, or extensive, when it affects the entire left ventricle, resulting in, for example, left heart failure.

A painless form of coronary heart disease is one that does not show pain in short-term attacks of ischemia. It can also be caused by neuropathy in diabetes.

It is also referred to as a silent form of coronary heart disease.

In the diagnosis of ischemic heart disease, a thorough taking of the anamnesis and the present clinical picture of the disease are used. There is a history of symptoms, especially anginal pain (ischemic animal pain) in the chest, shortness of breath, fatigue, exhaustion, and exercise difficulties.

Subsequently, laboratory blood tests, blood pressure, and pulse measurements are also used in determining the diagnosis. But also ECG, ECHO, or X-ray and sonography. Plus, stress tests are performed, such as exercise ECG in bicycle ergometry. A 24-hour ECG, ie the Holter ECG, is also used.

The diagnostic treatment method, namely coronarography  (angiography), can also be used for diagnosis. When inserted into a larger peripheral vessel, a catheter is inserted and a contrast agent is inserted during X-ray inspection. It then draws the condition of the coronary artery and a possible heart bleeding disorder.

The treatment method then involves angioplasty and known ballooning, with the introduction of a STENT to dilate the affected cardiovascular. This catheterization is important especially in acute coronary syndrome, ie heart attack, and unstable angina Pectoris.

The functional class of the disease is also determined according to the Canadian classification:

• Class I - tolerance of any effort
• II. class - tolerates walking on the plane for 200 meters or climbing the stairs to the 2nd floor
• III. class - tolerates only minimal effort
• IV. class - chest pain and at rest

It is an important differential diagnosis and differentiation from other diseases. Such as back pain or heartburn, but also mental difficulties such as anxiety.

TIP:  Interesting articles about back pain between the shoulder blades and oesophagitis  at the Medical Center.

The course of the disease can be acute or chronic. And like the symptoms, the course of the disease depends on factors such as the site of involvement of the vessel, the extent of its closure, and the total time.

The disease can be asymptomatic for a long time.

The first symptom is intolerance of exertion, load, increased fatigue. One gets tired or even short of breath during an activity when walking or walking upstairs for a long time. Chest pain may occur.

Then in peace, the difficulties subside within a few minutes.

The opposite is rest pain in the chest or shortness of breath. Altered and worsened difficulties of stable angina pectoris are also a warning.

Also a condition where nitroglycerin is not administered.

The acute coronary syndrome should be considered then.

An immediate professional examination is a matter of course. At this point, it is guaranteed to call 155, ie emergency medical service.

Interesting information:  Also read the article First aid for myocardial infarction.

The subsequent forecast is influenced by three factors, which are listed in the table

Preventive measures for coronary heart disease

Prevention has an important role in all cases, as well as in ischemic heart disease.

It is important to think about these measures before the onset or diagnosis of the disease. Of course, changing regime measures after difficulties have played an even more important role.

The table lists important preventive and regime measures