Ischaemic heart disease
65853
225249611
2008-07-12T18:13:00Z
Stevenfruitsmaak
247845
British English consistent with article title (although in Cat:Ischemic heart diseases ??)
{{unreferenced|date=December 2007}}
{{Infobox_Disease
| Name = {{PAGENAME}}
| Image =
| Caption =
| DiseasesDB = 8695
| ICD10 = {{ICD10|I|20||i|20}}-{{ICD10|I|25||i|20}}
| ICD9 = {{ICD9|410}}-{{ICD9|414}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = med
| eMedicineTopic = 1568
| MeshID = D017202
}}
'''Ischaemic''' or '''ischemic heart disease''' (IHD), or '''myocardial ischaemia''', is a [[disease]] characterized by reduced blood supply to the [[myocardium|heart muscle]], usually due to [[Coronary heart disease|coronary artery disease]] ([[atherosclerosis]] of the [[coronary artery|coronary arteries]]). Its risk increases with age, [[tobacco smoking|smoking]], [[hypercholesterolaemia]] (high [[cholesterol]] levels), [[diabetes mellitus|diabetes]], [[hypertension]] (high blood pressure) and is more common in men and those who have close relatives with ischaemic heart disease.
Symptoms of stable ischaemic heart disease include [[angina]] (characteristic [[chest pain]] on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. Diagnosis of IHD is with an [[electrocardiogram]], [[blood test]]s ([[cardiac marker]]s), [[cardiac stress test]]ing or a [[Coronary catheterization|coronary angiogram]]. Depending on the symptoms and risk, treatment may be with [[medication]], [[percutaneous coronary intervention]] (angioplasty) or [[coronary artery bypass surgery]] (CABG).
It is the most common cause of death in most Western countries, and a major cause of hospital admissions. There is limited evidence for population screening, but [[prevention (medical)|prevention]] (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications.
==Signs and symptoms==
Ischaemic heart disease may present with any of the following problems:
* [[Angina pectoris]] ([[chest pain]] on exertion, in cold weather or emotional situations)
* Acute chest pain: [[acute coronary syndrome]], [[unstable angina]] or [[myocardial infarction]] ("heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage)
* [[Heart failure]] (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle)
The [[medical history]] distinguishes between various alternative causes for chest pain (such as [[dyspepsia]], musculoskeletal pain, [[pulmonary embolism]]). As part of an assessment of the three main presentations of IHD, [[risk factor]]s are addressed. These are the main causes of [[atherosclerosis]] (the disease process underlying IHD): age, male sex, [[hyperlipidaemia]] (high [[cholesterol]] and high fats in the blood), [[tobacco smoking|smoking]], [[hypertension]] (high blood pressure), [[diabetes mellitus|diabetes]], and the [[Family history (medicine)|family history]].
==Diagnosis==
The diagnosis of ischemic heart disease underlying particular symptoms depends largely on the nature of the symptoms. The first investigation is an [[electrocardiogram]] (ECG/EKG), both for "stable" angina and acute coronary syndrome. An [[Chest X-ray|X-ray of the chest]] and [[blood test]]s may be performed.
[[Myeloperoxidase]] has been proposed as a [[biomarker]].<ref name="pmid18382609">{{cite journal |author=Loria V, Dato I, Graziani F, Biasucci LM |title=Myeloperoxidase: a new biomarker of inflammation in ischemic heart disease and acute coronary syndromes |journal=Mediators Inflamm. |volume=2008 |issue= |pages=135625 |year=2008 |pmid=18382609 |doi=10.1155/2008/135625 |url=}}</ref>
===Stable angina===
{{main|angina pectoris}}
In "stable" angina, chest pain with typical features occurring at predictable levels of exertion, various forms of [[cardiac stress test]]s may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), [[echocardiography]] (using [[medical ultrasonography|ultrasound]] of the heart) or [[scintigraphy]] (using uptake of [[radionuclide]] by the heart muscle). If part of the heart seems to receive an insufficient blood supply, [[Coronary catheterization|coronary angiography]] may be used to identify [[stenosis]] of the coronary arteries and suitability for [[angioplasty]] or [[Coronary artery bypass surgery|bypass surgery]].
===Acute chest pain===
{{main|acute coronary syndrome|myocardial infarction}}
Diagnosis of acute coronary syndrome generally takes places in the [[emergency department]], where ECGs may be performed sequentially to identify "evolving changes" (indicating ongoing damage to the heart muscle). Diagnosis is clear-cut if ECGs show elevation of the "[[Electrocardiogram#ST segment|ST segment]]", which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI); this is termed a STEMI (ST-elevation MI), and is treated as an emergency with either urgent [[Coronary catheterization|coronary angiography]] and [[percutaneous coronary intervention]] (angioplasty with or without [[stent]] insertion) or with [[thrombolysis]] ("clot buster" medication), whichever is available. In the absence of ST-segment elevation, heart damage is detected by [[cardiac marker]]s (blood tests that identify heart muscle damage). If there is evidence of damage ([[infarction]]), the chest pain is attributed to a "non-ST elevation MI" (NSTEMI). If there is no evidence of damage, the term "unstable angina" is used. This process usually necessitates admission to hospital, and close observation on a [[coronary care unit]] for possible complications (such as [[cardiac arrhythmia]]s - irregularities in the heart rate).
Depending on the risk assessment, stress testing or angiography may be used to identify and treat coronary artery disease in patients who have had an NSTEMI or unstable angina.
===Heart failure===
{{main|heart failure}}
In patients with [[heart failure]], stress testing or coronary angiography may be performed to identify and treat underlying coronary artery disease.
==Pathogenesis==
{{main|coronary artery disease}}
The disease process underlying most ischemic heart disease is [[atherosclerosis]] of the [[coronary artery|coronary arteries]]. The arteries become "furred up" by fat-rich deposits in the vessel wall (plaques).
Stable angina is due to inability to supply the [[myocardium]] (heart muscle) with sufficient blood in situations of increased demand for oxygen, such as exertion.
Unstable angina, STEMI and NSTEMI are attributed to "plaque rupture", where one of the plaques gets weakened, develops a tear, and forms an adherent [[thrombus|blood clot]] that either obstructs blood flow or floats down further the blood vessel, causing obstruction further down.
==Treatment==
In stable IHD, [[antianginal]] drugs may be used to reduce the rate of occurrence and severity of angina attacks. Treatments for acute coronary syndrome and established coronary artery disease is discussed above in "[[#diagnosis|diagnosis]]".
Treatment of coronary artery disease includes addressing "modifiable" risk factors. This includes suppression of cholesterol (usually with [[statin]]s), even in those with statistically normal cholesterol levels, control of [[blood pressure]], [[blood sugar]]s (if diabetic), regular exercise and a healthy diet. Smokers are encouraged to stop smoking.
==Prevention==
Various treatments are offered in people deemed to be at high risk of coronary artery disease. These include control of cholesterol levels in those with known high cholesterol, [[smoking cessation]], and control of high blood pressure.
==References==
{{reflist}}
{{Circulatory system pathology}}
[[Category:Cardiology]]
[[Category:Ischemic heart diseases]]
{{Link FA|pl}}
[[ca:Cardiopatia isquèmica]]
[[es:Cardiopatía isquémica]]
[[fr:Ischémie myocardique]]
[[it:Ischemia miocardica]]
[[ja:虚血性心疾患]]
[[pl:Choroba niedokrwienna serca]]
[[ru:Ишемическая болезнь сердца]]
[[uk:Ішемічна хвороба серця]]
[[zh:缺血性心臟病]]