A short guide to ischemic heart diseases (IHD)

What do you mean by a heart attack? Actually the term doesn't give you a full meaning about the underlying causes and the disease. My attempt is to give a short introduction and instructions about the major ischemic heart diseases. IHD (Ischemic heart diseases) is a group of diseases which are characterized by the ischemic conditions of the heart muscles. Heart muscle is the contractile apparatus which helps to pump blood through the body. For this we have a very complex network of blood vessels.

IHD group contains following diseases. Angina pectoris (Stable and Unstable), Myocardial Infarction, Majority of arrhythmias, and sudden cardiac death. What would happen if you can’t breathe? Sure you will die. The same conditions apply to the heart muscle. Underlying cases of majority of IHD are Atherosclerosis and coronary artery spasms.

Occlusion of coronary vessels may result decreased blood supply to the myocardium (Heart muscle). Keep in mind atherosclerosis is not the only reason for IHD.

An occluded vessel can supply the sufficient oxygenated blood to the heart muscle. Heart muscle needs oxygen and the other nutrients to its normal functions. If there is a misbalance between myocardial oxygen supply and demand it’s a problem. Such situations we called ischemic attacks. Ischemic attacks may be fatal but not always. The most dangerous IHD is MI. Due to the fatal effects. Some ventricular arrhythmias may be very dangerous too. In myocardial infarction there may be atypical types, which make it much dangerous.

Before that let’s discuss what are the typical and some of the common symptoms of IHD. First one is the Chest pain. In medicine this describes as a retrosternal pain. The same meaning! Sometimes this pain may be a dull, severe, just a discomfort, or a cutting like pain. 

The pain usually last some minutes. Lets consider angina pain. This is a transient ischemic pain. The pain is due to an atheroma. (Atheroma a aggregation of lipids and it is non soluble.) When the myocardial oxygen demand high and the supply are low the transient ischemic conditions rise. Gives such type of pain. This is the Stable angina pain. The common character of Stable, Unstable and MI pain is its radiation. Starting from the chest to the left shoulder, to the scapular (beck of the thoracic region) region, to Neck to the lower jaw usually.

What the stable angina pain duration? This last usually 15-20 minutes. What give the relief? Rest and Nitroglycerine. If you rest this is enough to decrease the stable angina pain. GTN is the best pain reliving drug. (Hospital admission is compulsory for such patients to put a clear diagnosis.)

Unstable angina is the worse type. Duration prolonged. Pain bit severe than the stable type angina. Pain lasts more than 30 minutes. Bed rest and GTN don’t give a relief from the pain. Such patients categorize as the patients with acute coronary Syndrome.  This is a borderline type of IHD between Angina and Myocardial death. There are several types of unstable angina. The main clinic shows that it doesn’t need physical exertion to provoke a heart attack (Ischemic episode) usually the unstable angina rise at the rest than the physical exertion. Types are as following-Accelerated type, new onset, Post MI, Variant Angina. Such patients need emergency medical intervention with cardiac reanimation facilities. Unstable angina attack management much like to Acute MI management. There are some differences. Medical approaches are the same.

In MI the ischemic myocardial damage is not reversible like Angina. MI causes Myocardial Death (Necrosis). Patients have a high mortality rate with MI. MI pathogenesis also associated with atherosclerosis. Rupturing the atheroma substances followed by activation of coagulation cascade and total occlusion of coronary artery causing myocardial death. Number of MI complications also very high. These severe complications increase the number of deaths due to MI.   

The atypical types of MI include Asthmatic form, cerebral form, gastrointestinal form, Silent form, and arrhythmic forms. These form Doesn’t have the usual clinic of MI.

Asthmatic form-a simple attack of asthma.

Cerebral form- Mimic a stroke and paralysis.

GIT form-Like gastritis or peptic ulcer disease.

Arrhythmic form- Several palpitations or tachycardia.  

Pain syndrome of MI (Myocardial Infarction) similar to Angina, but last long not responding to Nitrogycerines. Emergency hospitalization and medical intervention is mandatory.

Discussion is a short one. Theme is one of the biggest and most controversial. The treatment regimes still have big doubts. Management strategies change year by year according to the new epidemiological data and experiments. What we can do is to prevent from such diseases. I’m not going to write about prevention methods. Literatures about preventing heart diseases are very common. Anyone can read. Its not much difficult to prevent from a disease. Difficulty is to treat. Many chronic diseases have no definitive treatment. There is huge tendency to develop heart diseases, Diabetes and Chronic lung diseases in young age. Stay healthy! Don’t spend your good health to buy short satisfactions (Cigarettes, alcohols, and other narcotics) if you lost your health once, you can’t buy it again.

-Charith Kumara.

Kursk State Medical University. 

6th year.