Ischemic Heart Disease (IHD) is a condition in
which fatty deposits (atheroma) accumulate in the cells lining the wall of the coronary arteries. These fatty deposits
build up gradually and irregularly in the large branches of the two main coronary arteries which encircle the heart and are
the main source of its blood supply. This process is called atherosclerosis which leads to narrowing or hardening of
the blood vessels supplying blood to the heart muscle (the coronary arteries ). This results in ischemia ( inability
to provide adequate oxygen) to heart muscle and this can cause damage to the heart muscle . Complete occlusion of the blood
vessel leads to a heart attack (myocardial infarction).
In the United States
, cardiovascular disease is the leading cause of death among both sexes, and coronary artery disease is the commonest cause
of cardiovascular disease.
causes 35% of deaths in men between 35 and 50. The death rate is higher for men than for women between the ages of 35 and
55. However, after the age 55, the death rate for men declines but the rate for women continues to climb.
Exact cause is unknown. However there are a number of risk factors. Control of these risk factors has been shown to
reduce the severity and complications of the disease.
It is now clear that reducing certain risk factors, we can both prevent coronary artery disease and
delay its progression and complications after it it has become manifest. Treatment of lipid abnormalities has now been
shown to delay the progression of atherosclerosis and in some cases has even produced regression of the atherosclerotic plaques.
Signs & Symptoms
(burning, squeezing, heaviness, or tightness in the chest that may extend to the left arm, neck, jaw, or shoulder blade).
See Angina Pectoris.
Typically, angina is precipitated by physical activity, lasting no more than a few
minutes, and is relieved by rest. Usually angina is worse when exertion follows a meal. It is also worse in cold weather
and can be triggered by walking from a warm room into the cold air. Emotional stress can also cause or worsen angina.
Not all people with ischemia will present
with angina. Ischemia without angina is called silent ischemia. It is not yet understood why ischemia is sometimes silent.
Family history of
coronary artery disease, diabetes, high blood pressure or atherosclerosis.
Poor nutrition, especially too much fat in the diet.
Previous heart attack
and/or low level of HDL (high-density lipoprotein).
Type A personality
Diagnosis & Treatment
of angina is a clinical diagnosis based on a characteristic complaint of chest discomfort or chest pain brought on
by exertion and relieved by rest. Confirmation may be obtained by observing reversible ischemic changes on ECG
during an attack or by giving a test dose of sublingual nitroglycerin that characteristically relieves the pain in 1 to 3
tests may help determine the severity of ischemia and the presence and extent of the coronary artery disease. Diagnostic tests
may include electrocardiogram (measures electrical activity of the heart), echocardiogram (measures sound waves), exercise-tolerance
test, thallium stress test, blood studies to measure total fat, cholesterol and lipoproteins, X-rays of the chest and coronary
angiogram (cardiac catheterization).
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