Ischemic heart disease is a common cardiovascular condition caused by insufficient blood supply to the heart, primarily resulting from coronary artery stenosis or occlusion leading to myocardial hypoxia. This disease is a leading cause of death worldwide, especially in modern societies where unhealthy lifestyles and aging contribute to a rising incidence. Early understanding of its causes, symptoms, and preventive measures is crucial for reducing health risks.
The core issue of this disease is atherosclerosis of the coronary arteries, which involves the accumulation of fatty deposits within the vessel walls, gradually obstructing blood flow. When blood flow decreases to a level that cannot meet the myocardial demand, it triggers acute events such as angina pectoris or myocardial infarction. Modern medicine has developed various diagnostic and treatment techniques, but prevention remains the most effective strategy. This article systematically explains key information about ischemic heart disease to help readers develop a comprehensive understanding.
The pathological basis of ischemic heart disease is the process of atherosclerosis, mainly caused by lipid metabolism abnormalities, chronic inflammatory responses, and endothelial dysfunction. Excess low-density lipoprotein (LDL) infiltrates the vessel wall, binds with white blood cells, and forms foam cells, eventually leading to fibrous atheromatous plaques. When plaques rupture, platelets aggregate at the injury site to form thrombi, which can completely occlude the vessel, resulting in acute myocardial infarction.
Risk factors can be divided into controllable and uncontrollable categories. Uncontrollable factors include aging (men >45 years, women >55 years) and family history. Controllable factors include hypertension, hyperlipidemia, diabetes mellitus, smoking, lack of exercise, and obesity. Studies show that smokers have a 2-4 times higher risk of developing the disease, and diabetic patients have an increased incidence by 2-3 times due to combined microvascular and macrovascular damage.
The presentation of symptoms varies depending on the disease stage and individual differences. Typical angina pectoris is often described as a squeezing or dull pain behind the sternum, which may radiate to the left shoulder, neck, or jaw. This pain usually worsens with physical activity or emotional stress and alleviates with rest or nitroglycerin. About 30% of patients may be asymptomatic (silent angina), especially in diabetics who may have neuropathy leading to atypical symptoms.
The symptoms of acute myocardial infarction are usually more severe and persistent, often accompanied by cold sweat, nausea, difficulty breathing, or even syncope. A small proportion may present atypically, such as elderly patients experiencing only fatigue, anorexia, or cognitive impairment. Female patients more frequently report non-typical symptoms like epigastric discomfort or shortness of breath, which can delay diagnosis.
The diagnostic process typically involves initial assessment, functional testing, and invasive evaluation. Electrocardiogram (ECG) is the first-line screening tool, capable of detecting abnormalities such as ST-segment changes or T-wave inversions. Blood tests measuring cardiac troponins (cTn) are key indicators of myocardial injury, especially valuable in acute events.
Imaging examinations include echocardiography to assess ventricular function, nuclear medicine scans (e.g., myocardial perfusion imaging) to identify ischemic regions, and coronary angiography, which remains the gold standard for directly observing the degree of stenosis and plaque characteristics but is invasive and requires risk-benefit assessment.
Treatment strategies include medication, interventional procedures, and surgical options. Pharmacotherapy involves antiplatelet agents (e.g., aspirin) to prevent thrombosis, beta-blockers to reduce myocardial oxygen demand, nitrates to dilate blood vessels and increase blood flow. Statins are central to therapy, not only lowering cholesterol but also exerting anti-inflammatory and plaque-stabilizing effects.
Interventional treatment primarily involves percutaneous coronary intervention (PCI), including stent placement to restore blood flow immediately. Surgical treatment, such as coronary artery bypass grafting (CABG), is suitable for multi-vessel disease or left main stenosis and can significantly improve long-term prognosis. New techniques like atherectomy and drug-eluting stents continue to improve treatment outcomes.
Primary prevention focuses on controlling risk factors, with biannual screening of lipids and blood glucose recommended. Dietary principles include low-fat, high-fiber intake, with daily consumption of unsaturated fatty acids (e.g., fish oil) and antioxidants (e.g., vitamin E). Regular aerobic exercise (150 minutes per week of moderate intensity) can reduce the incidence by 30%.
Secondary prevention targets diagnosed patients, requiring combined pharmacological and lifestyle interventions. Quitting smoking can reduce the risk of heart disease by 50% within a year. Continued use of antiplatelet and lipid-lowering medications is crucial. Regular cardiac function assessments and coronary artery calcium scoring (CAC) can detect subclinical disease early.
If unexplained chest pain lasts more than 15 minutes, worsens at rest, or is accompanied by difficulty breathing or dizziness, seek immediate medical attention. Atypical symptoms such as unexplained arm pain, jaw radiation, or epigastric discomfort—especially in diabetics or the elderly—may hide serious conditions. Persistent cold sweat, irregular heartbeat, or chest discomfort lasting over 30 minutes are emergency indicators.
Regular screening is vital for high-risk groups. It is recommended that individuals over 40 or with a family history undergo annual heart risk assessments. Even mild symptoms like slight shortness of breath or decreased exercise tolerance warrant early evaluation. Delays in treatment for suspected acute coronary syndrome (ACS) can lead to myocardial necrosis and heart failure.
Angina is usually triggered by increased cardiac workload (such as exercise), lasting a few minutes and relieved by rest, classified as "stable angina." If chest pain lasts over 15 minutes and is accompanied by cold sweat or nausea, it may indicate myocardial infarction. Stable angina can be relieved by rest or nitroglycerin, but persistent chest pain requires immediate medical attention as it may signify worsening vessel blockage.
Besides ECG, what advanced tests do doctors perform to diagnose ischemic heart disease?Physicians may order stress tests (such as exercise ECG), myocardial perfusion scans, or coronary CT angiography to assess the degree of coronary artery stenosis. If severe obstruction is suspected, coronary angiography is performed to directly observe the location of narrowing and determine if intervention is necessary.
How does controlling blood sugar affect diabetic patients with ischemic heart disease?High blood sugar exacerbates endothelial dysfunction and plaque instability in coronary arteries, increasing the risk of heart attacks. Studies show that good glycemic control (HbA1c <7%) can reduce cardiovascular events by 16-22%. It is important to choose heart-friendly antidiabetic medications, such as SGLT2 inhibitors or GLP-1 receptor agonists.
After angioplasty, do patients still need to take antiplatelet drugs? For how long?Yes, after stent placement, dual antiplatelet therapy (e.g., aspirin + clopidogrel) is required for at least 6 months, and up to 1 year if drug-eluting stents are used. This reduces the risk of stent thrombosis. Afterward, patients usually continue on long-term single antiplatelet therapy. The duration and type of medication should be regularly evaluated with a healthcare provider.
Are symptoms of ischemic heart disease different in women after menopause? How to detect early?Postmenopausal women may present with atypical symptoms such as unexplained fatigue, epigastric discomfort, or shortness of breath rather than typical chest pain. Women experiencing non-specific symptoms along with high blood sugar or hypertension should proactively seek cardiac evaluation, including biomarkers like high-sensitivity troponin and imaging studies, for early detection of underlying issues.
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