Consultant cardiologist and researcher at the Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Dr. Akinlade Mathias, talks to ALEXANDER OKERE about ischaemic heart disease and other related conditions
What is ischaemic heart disease?
Ischaemia is a condition in which the blood flow (and in this case oxygen) is restricted or reduced in a part of the body. Ischaemic heart disease also known as IHD, therefore, encompasses conditions in which there is decreased blood flow (ischaemia) and oxygen (hypoxia) to the heart muscle commonly due to narrowing (atherosclerosis) of the blood vessels supplying the heart. This condition is also called coronary artery disease and coronary heart disease. This can ultimately lead to a heart attack. The resulting ischaemia and hypoxia lead to an accumulation of waste metabolites in the heart musculature which irritates the heart, resulting in chest pain or discomfort.
IHD is a spectrum of diseases resulting from the imbalance between the myocardial (heart) oxygen and blood supply and demands. It encompasses angina, myocardial infarction (death) and sudden cardiac death. Angina is described as chest pain or discomfort which may initially occur during stressful events or exercise (stable angina) or may later as the disease progress occurs even at rest (unstable angina).
How does IHD develop and what connection does it have with cholesterol?
IHD develops progressively from narrowing (atherosclerosis) of the blood vessels. Plaques made up mostly of cholesterol build up on the artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia. Also, the plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body. Another way is from coronary artery spasm. This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to parts of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia. The above mechanism results in the reduction of the ability of the blood vessels to supply oxygen and nutrients.
Is the disease one that Nigerians should be worried about?
Yes. We should be worried because of the rising prevalence of IHD due to westernisation, more awareness about it and more diagnosis now than before.
How prevalent is it in Nigeria and is it related to age and gender?
Most studies show that the prevalence of IHD in Nigeria is about one per cent. However, this is projected to increase in the coming years due to lifestyle changes, including smoking, sedentary lifestyle, increasing fat-based meals and obesity, and environmental pollution. The risk of IHD increases with increasing age, and is more predominant in males than females. However, the risk in women increases after menopause to a level similar in men, though these factors do not absolutely predispose to its development.
Are there risk factors that make an individual susceptible to ischaemic heart disease?
Several factors increase the risk of developing IHD. They are broadly grouped into modifiable and non-modifiable and include diabetes, high blood pressure, high blood cholesterol or fat level, tobacco, family history of heart attack and waist circumference. Both Type 1 and 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems. Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries. Cholesterol is a major part of the deposits that narrow the coronary arteries. A high level of “bad”; (low-density lipoprotein) cholesterol and low levels of good (high-density lipoprotein) cholesterol due to an inherited condition or a diet high in saturated fats and cholesterol.
Smoking and long-term exposure to second-hand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking causes the coronary arteries to spasm and may also increase the risk of blood clots. Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels. A waist measurement of more than 35 inches (89 centimetres) for women and 40 inches (102 cm) in men increases the risk of high blood pressure, diabetes, and heart disease. Also, not getting enough exercise contributes to obesity and is linked to higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better heart health, which is associated with a lower risk of myocardial ischaemia and heart attack. Exercise also reduces blood pressure.
Does the disease come with clear signs and symptoms?
What are they?
Some people don’t have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body regarded as heaviness and may be worse with activities. Other signs and symptoms, which might be experienced more commonly by women, older people and people with diabetes, include neck or jaw pain, shoulder or arm pain, fast heartbeat, shortness of breath when physically active, nausea and vomiting, sweating and fatigue.
Can panting after running a short distance be a sign of the disease and an impending heart attack or damage?
Easy tiredness during exercise may be a sign of IHD. However, this can also symbolise other diseases.
Some people experience irregular heartbeats at work or rest. Is this a medical concern?
Also, irregular heartbeats can be a source of concern. If this becomes a frequent event, then there is a need to be properly evaluated.
Many diseases go unnoticed and are mistaken for less serious ailments. Is it the same for ischaemic heart disease?
IHDs, like any disease, can be mistaken for other diseases. This is due also in part to the misinformation that’s pervasive in our environment.
What happens when ischaemic heart disease is left untreated and can it be fatal?
Myocardial ischemia can lead to serious complications if left untreated. These include heart attack, irregular heart rhythm and heart failure. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal. An abnormal heart rhythm can weaken your heart and may be life-threatening. Over time, repeated episodes of ischemia may lead to heart failure.
What is the first thing a person with the identified signs of ischaemic heart disease should do?
Whoever has any of the highlighted features should contact a medical practitioner, preferably a cardiologist, as soon as possible. Even those without symptoms but have the risk factors should also see a doctor.
How can the disease be diagnosed?
We diagnose it from the complaints the patient has, a blood test for cardiac enzymes and electrocardiography, among others. Other tests to risk stratify and make further definitive diagnosis or localisation of the point of narrowing may include cardiac stress and imaging tests e.g. stress ECG, stress echocardiography (cardiac ultrasound), CT angiography (dye test to outline the vessels), cardiac MRI, nuclear scanning like SPECT, etc.
Can the disease be treated with medications and are there side effects to look out for?
Yes. Depending on the stage and severity, medications will help to restore blood flow (thrombolysis) and preserve the flow (antiplatelets). Others will be very important at controlling the risk factors highlighted above. Your doctor will explain the details.
When is surgery necessary for the treatment of ischaemic heart disease?
It is useful to help restore blood flow in those who are unfit for medications, or who have multiple blockages of the vessels. Other forms of surgery may be needed to treat complications arising from the condition. A surgery could range from minimally invasive, called angioplasty, and open-heart surgery called coronary artery bypass surgery. Currently, many (medical) centres, both government and many private facilities, now offer these procedures.
Are there complications that may result from a surgical procedure?
Life and medical practice are based on risk-benefit assessment in all we do. Few complications may occur, but maybe not as important as leaving the vessels blocked which can lead to death. The cardiothoracic surgeons and interventional cardiologists will generally explain to the patients based on their peculiarities.
Are there certain things a person treated for the disease can do to improve the condition?
They should follow the doctors’ prescriptions and work together to set goals to reduce risk. They shouldn’t smoke and should avoid second-hand smoke. It is important to treat high blood pressure and get, at least, 150 minutes of moderate-intensity physical activity a week. It is also good to reach and maintain a healthy weight, control your blood sugar and see your doctor for regular check-ups.
What kind of diet would you recommend for a person recovering from the disease?
An individual recovering from IHD should eat more fruits and vegetables, eat a heart-healthy diet that’s low in saturated and trans fats, sodium (salt) and added sugars.
In what ways can the disease be prevented?
The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
The post Regular aerobic exercise reduces blood pressure, risk of heart attack —Cardiologist appeared first on Healthwise.