Ischemic Heart Disease: Causes, signs and treatment options

1. Definition & Epidemiology

Ischemic heart disease (IHD)—also called coronary artery disease (CAD)—is defined by impaired blood supply (ischemia) to the myocardium, usually due to narrowing or obstruction of the coronary arteries by atherosclerotic plaque. IHD is the leading cause of morbidity and mortality worldwide, particularly affecting adults over age 40 and those with major cardiovascular risk factors.

2. Pathophysiology

• Key Mechanism: Atherosclerosis—accumulation of cholesterol-laden plaques within coronary arteries causes luminal narrowing, reducing oxygen delivery to heart muscle.
• Acute events: Rupture of an unstable plaque with subsequent thrombus formation may cause complete occlusion, resulting in acute myocardial infarction (MI).
• Risk Factors:
  • Non-modifiable: Age, male sex, family history/genetics.
  • Modifiable: Hypertension, dyslipidemia, diabetes, obesity, smoking, sedentary lifestyle, stress, unhealthy diet.

3. Clinical Presentation

4. Diagnostic Approach

5. Management Strategies

A. Lifestyle Modification

• Mediterranean/heart-healthy diet (limit saturated fat, cholesterol, sugar).
• Regular aerobic exercise (30–45 min most days).
• Smoking cessation.
• Weight management and stress reduction.
• Blood pressure and diabetes control.

B. Pharmacologic Therapy

• Medication Adherence: Lifelong commitment; regular review for interactions and side effects.

C. Revascularization

6. Follow-Up and Long-Term Care

• Regular assessment: Blood pressure, lipid profile, glycemic status, ECGs.
• Comorbidity management: Diabetes, kidney disease, arrhythmia.
• Patient education: Symptom recognition, emergency response, medication side effects.
• Cardiac rehabilitation: Supervised exercise, risk factor education, psychological support.

7. Prognosis and Prevention

• Prognosis depends on degree of vessel involvement, comorbidity control, adherence to therapy.
• Primary prevention: Risk factor control before onset.
• Secondary prevention: Aggressive intervention post-MI or diagnosis to prevent recurrence or progression.

Summary Table: Textbook Comparison of Key IHD Treatments

References

• Braunwald’s Heart Disease (11th Edition)
• Harrison’s Principles of Internal Medicine (21st Edition)
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics (13th Edition, Cardiac Drugs section)
• Katzung BG, Basic & Clinical Pharmacology (15th Edition)
• ACC/AHA/ESC Guidelines on management of coronary artery disease

With a patient-focused, scientifically accurate approach, this chapter brings together etiology, symptomatology, diagnostic workup, therapy, and prevention as recommended by top clinical textbooks and guidelines.