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

Ischemic heart disease: Causes and symptoms of coronary heart disease?
Photo source: Getty images

Ischemic heart disease, also known as coronary heart disease, bothers us with insufficient blood supply to the heart. The main reason is the involvement of the heart, ie coronary vessels. It can be in acute or chronic form. The dreaded heart attack also includes the acute type.


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 acute form of coronary heart disease The chronic form of coronary heart disease
acute myocardial infarction (AIM) stable angina pectoris
unstable angina pectoris Prinzmetal's angina pectoris
sudden cardiac death coronary syndrome X
The collective name is also known as
ACS - Acute Coronary Syndrome
has no myocardial ischemia 
CHD with heart failure
CHD with cardiac arrhythmia
condition after myocardial infarction (MI)


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?

Coronary angiography, angiography, coronary artery occlusion
Coronary angiography shows the condition of the coronary arteries. Photo source: Getty images

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

Cause Description
Myocardial infarction (IM)
  • is caused by a sudden restriction of blood flow through the coronary artery
  • unstable atherosclerotic plaque
  • rupture of the atherosclerotic plaque and severe hemodynamic changes in blood flow through the vessel
  • subsequent thrombosis, platelet deployment
  • coronary artery spasm
  • it is typically manifested by chest pain, shortness of breath, and changes in the ECG
Unstable angina pectoris (NAP)
  • there is also a serious restriction of blood flow behind it
  • unstable atherosclerotic plaque
  • blood flow is maintained to such an extent that IM does not occur
  • altered, worsened stable angina pectoris
  • resting sore throat pectoris
  • difficulties subside after application of nitrates (NTG, nitroglycerin)
  • duration usually up to 20 minutes
  • retreat after reduction of the heart's claim to blood flow, after calming, interruption of exertion
  • increased effort can also be talking, a person is not able to talk longer without breathing and difficulty
  • changes on the ECG
  • chest pain
Sudden cardiac death
  • especially as a result of extensive MI with arrhythmia (malignant arrhythmia)
  • as the first manifestation of coronary heart disease
  • death occurs immediately or within 1 hour of the onset of the discomfort
  • affecting about 40% or more of the heart muscle
Stable angina pectoris (SAP)
  • recurrent short-term and reversible states of myocardial ischemia
  • difficulties are caused in particular by the increased demand of the heart for blood circulation
  • during exertion, physical or mental stress
  • stable atherosclerotic plaque
  • fatigue and shortness of breath with increased exertion or prolonged walking, or walking upstairs
  • in agitation and stress
  • chest pain, angina pectoris
  • or just shortness of breath without angina
  • pain subsides after application of nitrates (NTG)
  • and after calming down and interrupting the load
  • usually after a few minutes (5 - 15 minutes)
  • if the difficulties do not subside or worsen, you need to think about ACS
Printzmetal's angina pectoris
  • also referred to as variant - vasospastic AP
  • transient state of cardiac ischemia
  • occurs in peace
  • the cause is spasm, ie contraction of blood vessels
  • it can rarely be the cause of AIM, especially after cocaine ingestion
Coronary syndrome X
  • also, exercise difficulties
  • no stenosis or atherosclerotic vascular changes are seen
  • probably microvascular changes (at the level of small vessels)
  • also referred to as small vessel disease
CHD with heart failure
  • a condition in which the heart is unable to pump blood due to the need of the body
  • the most common cause of heart failure is coronary heart disease
  • the greater the damage to the cardiovascular system, the more significant the heart failure
  • long-term damage to the heart muscle and limitation of its function
  • may not be manifested by angina pectoris
  • mainly shortness of breath, fatigue, inefficiency, swelling
CHD with arrhythmias
  • arrhythmia may be the first manifestation of coronary heart disease
  • an example is the atrial fibrillation of the heart
  • the basis is a thorough treatment of arrhythmia and especially its cause, ie coronary heart disease
  • a complication of thromboembolization, especially a stroke
Condition after a heart attack
  • CHD is not lost even after overcoming the IM
  • risk condition
  • possible complications
He has no ischemic heart disease
  • takes place without manifestations
  • it is usually diagnosed randomly on an ECG
  • also the presence of cardiac arrhythmias


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.

ECG - STEMI - signs of ST elevation and heart muscle infarction
ECG signs of myocardial infarction. Photo source: Getty images

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

Factor Description
state of left ventricular systolic function how the heart can expel blood into the bloodstream, into the body
extent of endangered myocardium and the relationship to the extent and severity of ischemia
arrhythmogenicity heart rhythm disorders

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

Measure Description
Physical activity regular exercise, at least 30 minutes a day
or activity with higher intensity during the week
fast walking, swimming, cycling
in older age, regular walks are enough
Weight reduction BMI 18 - 25
for weight reduction requires a suitable diet regimen
together with sufficient physical activity for
at least 60 minutes a day
Fat restriction in particular saturated fatty acids, fried and smoked
Reduction of salt intake less than 6 g NaCl per day
A diet high in vegetables and fruits increase the intake of vegetables and fruits
at the same time healthy fats, fish, olive, linseed oil, nuts
fiber (plus cereals, legumes)
vitamins, minerals
Sufficient fluid intake in a healthy person more than 2 liters per day
in a warm and dry environment, in summer it is necessary to increase
Alcohol restriction men less than 30 ml of ethanol per day
which is 0.7 liters of beer or 3 DCL of wine
women less than 15 ml of ethanol per day the
best is complete abstinence
Smoking restrictions even, in this case, the best complete abstinence applies

How it is treated: Ischemic heart disease

How is ischemic heart disease treated: medications, angioplasty, BY-PASS?

Show more

In general about Ischemia

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Interesting resources

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  • "How Can Coronary Heart Disease Be Prevented or Delayed?". 
  • "How Is Coronary Heart Disease Treated?". 
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