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Ischemic Coronary Heart Disease

The coronary arteries branch off of the aorta (the main artery carrying blood from the heart) and wrap around the heart, carrying oxygen to the heart muscle. Coronary heart disease occurs when coronary arteries become blocked, diminishing the blood supply to the heart muscle and resulting in ischemia, an inadequate supply of blood that causes damage to the heart muscle from insufficient oxygen.

  1. Atherosclerosis

    • The most common cause of ischemic coronary artery disease is atherosclerosis in which fatty deposits (plaques) build up in the arteries, gradually decreasing the lumen (opening) so that when the heart is stressed (such as during exercise), it can't pump enough blood through the narrowed opening to supply the oxygen needed, and the area of muscle fed by the blocked coronary artery is damaged.

    Symptoms

    • When ischemia occurs and the heart muscle doesn't receive enough oxygen, chemical changes take place in the muscle, sending a message (impulse) of pain along the nerves to the brain. These impulses travel along the same nerve routes as nerves from the shoulders, neck and left arm, so heart pain may be felt in the heart area (angina) and these other areas as well.

    Risk Factors

    • According to the American Heart Association, risk factors for atherosclerosis and ischemic coronary disease include high blood pressure, smoking (including second-hand exposure), high cholesterol levels (especially LDL above 100 mg/dL), sedentary lifestyle, obesity and disease (such as other cardiovascular disorders and diabetes). Males have higher rates of coronary heart disease than females

    Complications

    • The heart tries to compensate for the partially blocked arteries by growing new smaller arteries (collaterals) to improve blood supply. When plaques occur in the coronary arteries, they also usually occur in other arteries in the body as well, so the heart has to pump harder to get the blood through the vessels. This causes blood pressure to increase and the heart muscle to enlarge and weaken, resulting in heart failure. Without treatment, a coronary artery may completely occlude (block), causing a heart attack, severe damage to the heart muscle and sometimes death.

    Medical Treatment

    • A wide range of medications are used to treat ischemic coronary heart disease, depending upon the severity and the complications. Initial treatment usually includes vasodilators (such as nitroglycerin) to dilate (open) the arteries and improve blood flow, medications to lower cholesterol and reduce plaque formation (such as statins) and diuretics (water pills) to reduce high blood pressure.

    Surgical Treatment

    • According to the American Heart Association, if medical treatment is insufficient, surgical procedures can include balloon angioplasty, in which the surgeons inserts a plastic catheter in the groin area and threads it up into the coronary vessels to the blockage and inflates a balloon to open the vessel. The surgeon may also insert a mesh metallic tube, called a stent, to keep the artery open. If the blockage area is large or multiple areas are blocked, the surgeon may do a bypass graft in which a vein from another part of the body, such as the leg, is removed and used to replace the blocked coronary artery.

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