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Ischemic cardiomyopathy

Cardiovascular diseases are the leading cause of death in developed countries. In particular, ischemic heart disease and its complications continue to represent one of the significant causes of morbidity and mortality in the population.

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This section will explain some concepts of interest to the patient in an entertaining and summarized way because knowing about the disease helps understand the treatment options, promote lifestyle changes, and participate actively with the team of professionals who care for you.

What is ischemic heart disease?

The term refers to diseases caused by the lack of blood supply to the heart (oxygen and nutrients). Mostly, it is a consequence of atherosclerosis's obstruction in the arteries responsible for blood supply.

 

It may also occur without obstruction, for example, when microcirculation disturbances arise due to small blood vessels. It is possible to have angina without lesions in the heart's arteries, which is more frequent in women, or in situations that require high oxygen demand in diseased hearts, such as arrhythmia, anemia, or intense physical exercise.

 

Many patients with obstructive lesions in the coronary arteries may be asymptomatic for years. In others, it manifests with a "sudden death" or with some symptoms. The main characteristic is chest pain, which we call "typical": oppressive or with a sensation of heaviness, related to exertion and relieved by rest; the pain radiates to the left arm, neck, or jaw and is accompanied by sweating or nausea.

 

The forms of presentation are as follows:

 

  • Stable angina: The atherosclerosis of the heart's arteries does not cause complete obstruction of the vessel's lumen. It means that blood continues to flow, but in situations requiring an extra supply of oxygen (physical exercise, sexual activity, emotional impact, and even after a large meal), it cannot pass the amount necessary for the needs of the muscle. It is then that clinical manifestations appear, such as pain, which is usually relieved by rest. Episodes of chest pain evolve over several months.

 

  • Unstable angina: If the obstructive lesion progresses, symptoms worsen in patients with a history of typical chest pain or already diagnosed with ischemic heart disease. They may appear with less exertion or even at rest.

 

  • Acute myocardial infarction: When the muscle suffers from an injury, the cells begin to die and release troponins proteins into the blood. Lab tests determine if there is an "infarction." An unmistakable symptom is a typical pain that may last over 20 minutes and appears at rest. Suppose the lesion completely occludes the entire lumen of the vessel. In that case, the patient is experiencing an "acute myocardial infarction," with or without ST-segment elevation. The latter is determined by an electrocardiogram test (ECG), a MUST on every patient with chest pain during the first minutes of medical care.

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Advice that can save your life

Are you a patient with risk factors? Have you been diagnosed with ischemic heart disease? If you have an episode of chest pain (oppressive, triggered by exertion, and radiating to the left arm, neck, or jaw), call the emergency services (112) instead of going to the hospital or medical center on your own, much less driving yourself.

 

Why? The emergency services can do an electrocardiogram at your home and activate a "Reperfusion Code" protocol. After doing this, they take you to a hospital where they can reestablish the flow of the occluded artery through a procedure called "catheterization," with which they implant a prosthesis or "coronary stents" and thus avoid further damage. For a patient with chest pain, every minute counts.

What are the causes of ischemic heart disease?

The appearance of atherosclerosis in the coronary arteries is studied through pathophysiology and has multiple causes related to inflammation and oxidation. However, you can control some of the risk factors to prevent the onset of the disease.

 

Non-controllable risk factors: advanced age; sex (it is more common in men, although the frequency in women becomes equal after menopause); history of premature ischemic heart disease in the family.

 

Controllable risk factors: increase in total cholesterol levels, especially LDL (bad) cholesterol, decrease in HDL (good) cholesterol levels; smoking; arterial hypertension; diabetes mellitus; obesity; sedentary lifestyle; previous history of the disease: patients who have already had angina or infarction are at greater risk of recurrence. 

How is the disease diagnosed?

The usual symptom that prompts the patient to request medical care is chest pain, but also dyspnea, dorsal or epigastric pain, sweating, nausea, and vomiting may occur.

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In patients with clinical symptoms of weeks of evolution, your physician will refer you to a cardiologist for additional testing and provide a detailed medical history. In addition to an ECG and an echocardiogram, you may undergo a stress test, a stress echocardiogram, a coronary CT, or nuclear medicine techniques (SPECT).

How is it treated?

The treatment of ischemic heart disease has evolved considerably thanks to interventional techniques, the universalization of primary angioplasty programs, cardiac surgery, and new drugs to control risk factors associated with coronary diseases, hypercholesterolemia, diabetes, as well as cardiovascular disease rehabilitation programs. All of the above is incomplete if the patient does not actively treat their illness through healthy lifestyle habits, a healthy diet, and physical exercise.  

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The treatment's choice depends on factors such as age, the form of presentation (acute infarction, stable angina), the type and complexity of the lesions present in the coronary arteries, other diseases present such as diabetes, pathologies that favor bleeding, the hospital's experience or the patient's decision.

What to do when faced with an episode of chest pain if you are already under treatment?

First: stop the activity you were doing and sit down. Administer yourself one sublingual Cafinitrina (nitroglycerin). If, after 5 minutes, the pain has not subsided, you may take another dose. Then:

 

  • Suppose the pain has subsided and had the typical characteristics (in frequency, duration, and degree of effort in which it appears). In that case, you may continue with your day, and it is not necessary to go to the doctor.

 

  • If the pain disappears, but it was more frequent, lasted longer, or appeared with minor efforts, ask for a consultation with your physician.

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  • If the pain lasts more than 15 minutes, without subsiding after 2-3 doses, or if you are also experiencing difficulty breathing, dizziness, palpitations, or loss of consciousness, seek medical help by calling the emergency services through telephone 112.

Can I return to work after a heart attack?

Usually, the answer is yes. But first, it is necessary to assess the heart's function and what type of work activity the patient performs. If your heart function is compromised, and you were working as a stevedore, you will likely have to change your job and adapt it to your current situation.

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Also, you must wait at least three weeks after the coronary syndrome to drive and at least one month to travel by plane. 

What about my sex life?

Patients with ischemic heart disease can usually have a good sex life. Sexual activity may resume two weeks after coronary syndrome.

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Some drugs can interfere with libido, and others contraindicate specific treatments for erectile dysfunction (nitrates). If in doubt, do not hesitate to ask your doctor.

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How can I control my disease?
Advice from the Spanish Society of Cardiology

  1. Quit smoking: give up smoking entirely and avoid being in smoky environments.

  2. Limit alcohol consumption: for men, the daily maximum is two glasses of wine; one for women.

  3. Blood pressure control: values should be less than 135/85.

  4. Glycemic control: if you have diabetes, your values should be between 90-140 mg/dl or the glycosylated hemoglobin value <7%.

  5. Control of cholesterol levels: the value of "bad" cholesterol or LDL must be less than 70 mg/dl or reduced by 50% concerning the initial value. Do stop taking your medication. Three months after discharge, and then annually, you should have blood tests to achieve and maintain this goal.

  6. Weight control: the target body mass index is BMI<25. Your waist should be less than 102 cm if you are a man and less than 88 cm if you are a woman.

  7. Heart-healthy diet: low in salt (maximum 6 g/day), low in animal fats, deli meats, precooked foods, and avoid fried foods and stews. Rich in vegetables and fruits. Use olive oil. Choose skimmed dairy products. Oily fish once a week. Maximum 3 eggs per week. Cook with steam, oven, grill, or ember.

  8. Physical exercise: it is advisable to do an aerobic physical activity of moderate intensity (swimming, walking, or cycling) for at least 20-30 minutes a day, 5 to 6 times a week. Avoid doing it after meals or in extreme temperatures.

  9. Pharmacological compliance: you must constantly and regularly comply with the prescribed treatment. Remember your treatment is individualized and adjusted to your needs. If you have had a stent placed, always tell the attending physician and never abandon therapy with aspirin or any other antiplatelet agent unless expressly indicated by a doctor.

  10. Vaccinations: you should be vaccinated annually against influenza. We recommend Pneumococcal vaccination as well.

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