Ischaemic heart disease

Ischaemia means a "reduced blood supply". The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries reduces the supply of blood to heart muscle.

Most ischaemic heart disease is caused by atherosclerosis.

What is it?

• Initially there is narrowing of coronary arteries causing angina.
• The narrowing is mostly caused by fatty plaques lining the wall of the artery.
• Sometimes a fatty plaque will rupture leading to a heart attack. (Heart attacks caused by simple narrowing are relatively uncommon).
• A heart attack causes damage to heart muscle by cutting off its blood supply.

This can cause:

• Temporary damage and pain (ischaemia[?])
• Loss of muscle activity (acute heart failure)
• Permanent heart muscle damage (acute myocardial infarction /infarct)
• Long term loss of heart muscle activity (chronic heart failure)
• Cardiac arrhythmias: irregular heartbeat which can be fatal.
• Other structural damage to the heart including damaged heart valves[?], actual perforation of the heart and a thin walled fibrous floppy heart.

Prevention. Prevent or delay atherosclerosis.

• Do not smoke.
• Treat hypertension (high blood pressure)
• Exercise regularly (Exercising the heart muscle strengthens it, like any other)
• Avoid obesity: a large body puts unnecessary strain on the heart and increases serum cholesterol and triglycerides[?].
• Avoid excess saturated fat in the diet. Some unsaturated fats may be beneficial in reducing the risk of heart disease when consumed in moderation. Dietary cholesterol is shown to have a modest effect on serum cholesterol.
• Take cholesterol reducing drugs.

Treatment of a heart attack. Which of these options are required depends on the situation.

• Specialised coronary care (the sooner the better).
• Cardiopulmonary resuscitation (heart massage).
• A defibrillator can revert cardiac arrhythmias.
• An artificial pacemaker can prevent cardiac arrhythmias.
• Drugs such as adrenaline can increase heart rate.
• Thrombolytic[?] agents can clear away the causative blood clot.
• Anticoagulation[?] can prevent additional blood clots.
• Inotropic drugs[?] will raise blood pressure.
• Unblock arteries with surgery or angioplasty ("balloon angioplasty")

After a heart attack

• Possible cardiac surgery.
• Possibly the regular administration of anti-coagulants to prevent further arrhythmias
• Possibly the regular administration of drugs to control heart rhythm.
• Increase exercise within limits of safety (see prevention) to train the heart.