Heart disease, specifically ischaemic heart disease or myocardial infarction or heart attack (these terms mean the same thing), is one of the most important medical conditions. Heart disease is responsible for 10-15% of deaths worldwide (although importantly, if we were considering the broader category of cardiovascular disease, which includes strokes, cardiovascular disease accounts for about a third of all deaths worldwide). Cardiovascular disease and heart disease have (more or less) the same root causes and the same lifestyle risk factors and so can be considered among the most preventable of conditions. Let us consider some of the jargon and technical terminology used here…
Cardiovascular disease – this broad term refers to all conditions that are caused by problems with blood circulation. The most important are heart disease, stroke, and peripheral vascular disease (poor circulation, usually affecting the feet and legs).
Heart – the heart is a muscular organ located in the mid-left of the chest, between the two lungs. It is a four-chambered pump that pumps blood around the body. The heart is essential for life and for the healthy functioning of the entire body. The heart itself, being a muscle, requires its own blood supply, which it receives through the coronary arteries – in this sense it pumps blood to itself.
Lungs – the human body has two lungs and their role is to breathe in air that includes oxygen and to deliver this oxygen to circulating red blood cells, simultaneously removing carbon dioxide (CO2) from the blood.
Blood – blood is a critical bodily fluid that continually circulates around the body. It performs many important functions but in the context of heart disease the most important is that blood circulates red blood cells that contain oxygen, which is essential for life and the healthy functioning of all organs.
Ischaemic Heart Disease (IHD) – this refers to all conditions that are caused by a reduced or restricted blood flow to the heart. The resulting reduced oxygen supply to the muscle of the heart causes IHD.
Angina – this refers to IHD symptoms and conditions that are not permanent i.e. angina is a form of IHD that is not permanent and does not involve the actual death of heart muscle cells. Angina can be considered a warning sign for a heart attack.
Myocardial Infarction (heart attack) – this is a more severe form of IHD where some heart muscle cells are so short of oxygen that they are permanently damaged and or die.
Symptoms of IHD – IHD (angina and or heart attack) usually presents with chest pain (central crushing pain) that may or may not radiate to the jaw and or arm (usually left), shortness of breath, sweatiness, anxiety (fear of dying is often sensed), nausea, and fatigue. In some 5% of cases there are actually no noticeable symptoms and in almost a third of cases the symptoms are atypical (unusual).
Emergency care of IHD – any patient who is thought to be having an episode of IHD should be rushed to a hospital immediately because prompt and advanced medical care can positively affect the outcome whereas delay can worsen the outcome significantly. Aspirin (one tablet) is helpful unless it is contraindicated for some reason (e.g. patient is allergic or intolerant of aspirin). Time is of the essence, minutes count. If ambulance services are slow or unreliable the use of personal or private transport may well be best.
Treatment of IHD – this has advanced significantly in recent years such that the death rate from IHD is actually declining in many developed countries (although the same cannot be said of developing countries with less advanced healthcare services). A combination of advanced medications and specialised procedures including stents and bypass surgery are used. This is a highly specialised field and the science is ever-evolving.
Heart disease risks – it is generally understood that there are a number of risk factors for the development of IHD. The most important risks that cannot be modified are age and family history. The most important risk factors that can be modified are overweight, lack of exercise, smoking, excessive alcohol use, high blood pressure, diabetes and high cholesterol.
Prevention of heart disease – the most powerful preventive measures are lifestyle changes (weight loss, exercise, quitting smoking, etc.) but medications can also be helpful (managing diabetes and high cholesterol and high blood pressure effectively, the use of aspirin long term, certain heart medications, etc.).
While this list is not comprehensive or complete, it hopefully helps in demystifying this critically important group of conditions. Armed with clearer understanding, our hope is that you can reduce your risk of developing this killer.
Written by Dr Colin Burns
