Ischemic heart disease is a common cardiovascular condition caused by insufficient blood supply to the heart, primarily due to narrowing or blockage of the coronary arteries leading to myocardial hypoxia. This disease is a leading cause of death worldwide, especially in modern societies where unhealthy lifestyles and aging contribute to its increasing incidence. Understanding its causes, symptoms, and preventive measures early is crucial for reducing health risks.
The core issue of this disease is atherosclerosis, which involves the deposition of fat within the vessel walls forming plaques that gradually obstruct blood flow. When blood flow decreases to a level that cannot meet the myocardial demand, it can trigger acute events such as angina or myocardial infarction. Modern medicine has developed various diagnostic and treatment techniques, but prevention remains the most effective strategy. This article will systematically outline key information about ischemic heart disease to help readers build a comprehensive understanding.
The pathological basis of ischemic heart disease is the process of atherosclerosis, with primary causes including lipid metabolism disorders, chronic inflammatory responses, and endothelial dysfunction. Excess low-density lipoprotein (LDL) infiltrates the vessel walls, combining with white blood cells to form foam cells, ultimately leading to the formation of fibrous atheromatous plaques. When these plaques rupture, platelets aggregate at the site of injury to form a thrombus, which may completely obstruct the vessel, resulting in acute myocardial infarction.
Risk factors can be divided into controllable and uncontrollable categories. Unmodifiable risks include aging (men > 45 years, women > 55 years) and family history. Controllable factors encompass hypertension, hyperlipidemia, diabetes, smoking habits, lack of exercise, and obesity. Studies show that smokers have a 2-4 times higher risk of developing the disease compared to non-smokers, while diabetic patients experience a 2-3 times increased incidence due to the combined effects of microvascular and macrovascular complications.
Symptoms vary depending on the stage of the disease and individual differences among patients. Typical angina is often described as a pressure or discomfort behind the sternum, which may radiate to the left shoulder, neck, or jaw. This pain usually worsens with physical activity or emotional stress and is relieved by rest or the use of nitroglycerin. About 30% of patients may have no obvious symptoms (silent angina), especially diabetic patients who may present with atypical symptoms due to nerve damage.
Symptoms of acute myocardial infarction are typically more severe and persistent, possibly accompanied by cold sweat, nausea, shortness of breath, or even fainting. A minority of patients may present atypically, such as elderly individuals who may only experience fatigue, loss of appetite, or cognitive impairment. Female patients more often report atypical symptoms, such as discomfort in the upper abdomen or shortness of breath, which may lead to delayed diagnosis.
The diagnostic process typically consists of three stages: initial assessment, functional testing, and invasive evaluation. Electrocardiography (ECG) is the preferred screening tool, capable of capturing ST segment changes or T wave inversions. Elevated levels of cardiac troponin (cTn) in blood tests are key indicators of myocardial injury, particularly valuable in acute events.
Imaging examinations include echocardiography to assess ventricular function, and nuclear medicine tests (such as single-photon emission computed tomography) can reveal ischemic areas. Coronary angiography remains the gold standard, allowing direct observation of the degree of vessel narrowing and plaque characteristics, but it is an invasive test that requires weighing risks and benefits.
Treatment strategies are divided into three categories: medication, interventional therapy, and surgical treatment. Medication includes antiplatelet agents (such as aspirin) to prevent thrombus formation, beta-blockers to reduce myocardial oxygen demand, and nitrates to dilate blood vessels and increase blood flow. Statins are a cornerstone of treatment, not only lowering cholesterol but also providing anti-inflammatory and plaque-stabilizing effects.
Interventional therapy primarily involves percutaneous coronary intervention (PCI), including stent placement to immediately restore blood flow. In terms of surgical treatment, coronary artery bypass grafting (CABG) is suitable for patients with multivessel disease or left main stenosis, significantly improving long-term prognosis. Newer treatment techniques such as atherectomy and drug-eluting stents continue to enhance therapeutic outcomes.
Primary prevention focuses on controlling risk factors, with recommendations for lipid and glucose screening every six months. Diet should follow principles of low fat and high fiber, with daily intake of unsaturated fatty acids (such as fish oil) and antioxidant nutrients (such as vitamin E). Regular aerobic exercise (150 minutes of moderate-intensity exercise per week) can reduce the risk of disease by 30%.
Secondary prevention targets diagnosed patients, requiring a dual approach of medication and lifestyle changes. The risk of heart disease can be reduced by 50% one year after quitting smoking, and continuous use of antiplatelet and lipid-lowering medications is crucial. Regular assessments of cardiac function and coronary artery calcium (CAC) scoring can help detect subclinical disease early.
If you experience unexplained chest pain lasting more than 15 minutes, worsening pain at rest, or accompanied by shortness of breath or dizziness, seek medical attention immediately. Atypical symptoms such as unexplained pain in the left arm, jaw pain, or upper abdominal discomfort, especially in diabetic or elderly patients, may conceal serious underlying conditions. Persistent cold sweat, irregular heartbeat, or chest discomfort lasting more than 30 minutes without relief are all emergency indicators.
Regular screening is vital for high-risk groups, with recommendations for annual cardiac risk assessments for those over 40 or with a family history. Even mild symptoms (such as slight shortness of breath or decreased exercise tolerance) should prompt early medical evaluation for cardiac function testing. Delaying treatment for suspected acute coronary syndrome (ACS) may lead to myocardial necrosis and heart failure.
Angina is usually triggered by increased cardiac workload (such as exercise) and the pain lasts for a few minutes before subsiding, classified as "stable angina"; if chest pain lasts more than 15 minutes and is accompanied by cold sweat and nausea, it may indicate myocardial infarction. Stable angina can be relieved by rest or nitroglycerin, but persistent chest pain that does not subside requires immediate medical attention, as it may indicate worsening vessel blockage.
When diagnosing ischemic heart disease, what advanced tests will doctors perform besides an ECG?Doctors may arrange for stress tests (such as exercise ECG), nuclear medicine myocardial perfusion scans, or coronary CT angiography to assess the degree of coronary artery narrowing. If severe blockage is suspected, a cardiac catheterization (angiography) will be performed to directly observe the location of vessel narrowing and determine whether interventional treatment is necessary.
How does blood sugar control affect the condition of diabetic patients with ischemic heart disease?High blood sugar exacerbates endothelial dysfunction and plaque instability in the coronary arteries, increasing the risk of heart attacks. Studies show that good blood sugar control (HbA1c < 7%) can reduce cardiovascular events by 16-22%. When treating, it is essential to choose diabetes medications that are more heart-friendly, such as SGLT2 inhibitors or GLP-1 receptor agonists.
After undergoing angioplasty, do patients still need to take antiplatelet medications? For how long?Yes, after placing a coronary stent, dual antiplatelet therapy (such as aspirin + clopidogrel) is required for at least 6 months; if a drug-eluting stent is used, this duration extends to 1 year. This measure reduces the risk of thrombosis within the stent, after which patients can switch to long-term single antiplatelet therapy. During this period, it is important to monitor for bleeding risks and regularly evaluate the benefits of the medication with a physician.
Do symptoms of ischemic heart disease differ in women after menopause? How can early detection be achieved?Female patients may present with atypical symptoms, such as unexplained fatigue, upper abdominal discomfort, or shortness of breath, rather than typical chest pain. It is recommended that postmenopausal women who experience nonspecific symptoms accompanied by high blood sugar or high blood pressure should proactively request a cardiac function assessment, including blood biomarkers (such as high-sensitivity cardiac troponin) and imaging tests to detect potential issues early.
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