Understanding Ischemic Heart Disease

The “silent” form of heart disease

More than 3 million cases of ischemic heart disease are diagnosed every year in the United States. Most patients don’t know they have it, until after suffering a heart attack.

Part of what makes ischemic heart disease so mysterious lies in its name. Also known as coronary artery disease, this form of heart disease damages the heart’s major blood vessels. Ischemia is when the blood flow (which includes oxygen) is restricted or reduced in part of the body. Cardiac ischemia is when decreased blood flow or lack of oxygen affects the heart muscle. According to the Mayo Clinic, a majority of ischemic heart disease patients are over the age of 60, people between the ages of 40 and 60 are also affected. What alarms cardiologists is the growing number of younger patients being diagnosed with ischemia as early as 19 years old.
Dr. Brion Winston is a board certified cardiologist with Capital Cardiology Associates, who performs diagnostic catheterizations and percutaneous interventions for heart and vascular disease at St. Peters and Albany Medical Center. When it comes to ischemic heart disease, he is a specialist.

“Numerically speaking, I see most people before they have a heart attack. I’m seeing people who high blood pressure, diabetes, or perhaps have peripheral vascular disease,” says Winston. “When you speak to a cardiologist, if you ask, ‘what is a heart attack?’, what we generally agree upon is the sudden deprivation of blood and oxygen to the heart muscle most often from a blockage from ruptured plaque in an artery. That is the most feared end point in ischemic heart disease.”

Silent and Deadly

The problem with patients who have ischemia is that may have an episode without knowing it. That’s why it’s called “silent ischemia” — people have a heart attack with no pain or warning signs. For patients who go undiagnosed or are at high risk for heart disease, the chance for a heart attack develops over the course of several years as a blockage in their heart arteries. For those patients, Winston points out, “this can lead to chest pain from reduced blood and oxygen to the heart muscle. Most often men would describe this as a tightness or heaviness of the chest, sometimes using their fist to describe the feeling.”
Since heart disease is the number one killer of men and women in the United States, there is a difference on how men and women will present symptoms. Men tend to display the classic signs as Winston described above, however, “women are less common to have the feeling of chest pain, like an elephant sitting on their chest. Instead they may feel back pain, pain between the shoulder blades, or fatigue. Women’s symptoms tend to be less typical.” This is another reason why this silent killer is so dangerous, you could not feel anything as ischemia develops or mistake the warning signs for the flu, muscle pain, or “old age.”

Prevention Is The Best Cure

As with most forms of heart disease, the treatment for ischemic heart disease includes lifestyle changes, medications, angioplasty, and surgery. Dr. Winston advises that preventing your risk of heart disease starts with a living a heart healthy life. “People need to think of their heart as an organ and muscle that needs to be worked out rather than an inert organ that they have no control over,” noted Winston. “Like any muscle, your heart should be exercised. Regarding the kind of exercise would be most health: any and all of it! We’ve looked at endurance training, interval training, walking — the signal that we keep seeing over and over is that it’s all healthy. Any activity is healthy for your heart. An interesting follow up is, ‘is the exercise going to make me live longer?’ Yes, and it helps us live better.”
Even for individuals with a family history of heart disease or who are predisposed to heart health issues due to other genetic factors, people who exercise regularly and follow a healthy diet tent to recover faster from heart conditions. I will give you one example of this,” begins Winston. “I have had over the course of my career several patients who were very healthy, as far as their diet and exercise goes. They could be a long-distance cyclist or runner and low and behold the come as a patient in their 60’s or 70’s and the have blocked arteries and need bypass surgery. This may because of their genes, a family medical history that made them more predisposed of inheriting blocked arteries. Or, perhaps they smoked for twenty years or twenty years ago when they were younger. Whatever the reason, they tend to do much better in their treatment, tolerating by-pass surgery in particular. These individuals, who exercise regularly, bounce back quicker. They are out of the hospital in four days versus ten.”
Written by: Michael Arce, Media Specialist

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