Q&A Topic: Ischemic Heart Disease
Julio A. Panza, MD
Q: What is ischemic heart disease?
A: Ischemic heart disease is a condition in which the working muscle of the heart is affected by poor delivery of blood flow from the coronary arteries, most commonly as a result of obstruction of those arteries by plaques of cholesterol that form over many years. The heart is a complex organ, with muscle, valves, and vessels that supply blood flow—the coronary arteries. When the coronary arteries are blocked, ischemia ensues. Ischemia is a situation in which the normal balance between the supply and demand of oxygen is disrupted. This usually, but not always, occurs as a consequence of obstructions that develop in the coronary arteries due to cholesterol deposition in the vessel wall, a process called atherosclerosis. A complete occlusion of the coronary arteries can suddenly happen and cause a heart attack—a myocardial infarction—when the cholesterol plaque ruptures abruptly, and a clot develops inside the vessel very quickly. Ischemic heart disease is the most common form of heart disease.
Q: What makes it so fascinating to study?
A: The study of ischemic heart disease requires an understanding of all facets of cardiology, from prevention and management of risk factors for atherosclerosis (high blood pressure, high cholesterol, diabetes, and smoking) to the treatment of the early presentations of the disease, and finally the management of acutely ill patients. It is also very rewarding, because patients in dire clinical situations have the opportunity to recover to a productive life in a relatively short period of time, if treated appropriately.
Q: Given that heart disease is the leading cause of death in the United States today, should everyone be tested for risk?
A: Actually, in people who are asymptomatic, testing can be controversial, because sometimes the risk of action overwhelms any benefit. Asymptomatic people are generally only screened in specific situations—for instance, if you’re beginning an aggressive exercise program, or if you have overwhelming risk factors.
Q: How do you treat heart disease?A: There are three overarching strategies:1. Primary prevention concerns how to reduce risk by –for example—treating cholesterol, smoking cessation, and controlling certain conditions, such as high blood pressure and diabetes.2. Secondary prevention concerns what happens once the disease is established. How do you prevent its progress?3. Addressing the complications involves treating heart attacks and other urgent medical crises of various levels of severity. We have many tools in our armament. For instance, statin drugs can be used during both primary and secondary prevention. Statins have cholesterol-lowering effects as well as vascular and anti-inflammatory effects. Doctors also frequently prescribe ACE inhibitors, beta-blockers, anticoagulants and other medicines depending on patient needs and risk factors.
Q: What do you wish more people knew about heart disease?
A: Even minor delays when treating a heart attack can have major consequences. If you or someone you love experiences symptoms of a heart attack, seek prompt treatment. In the case of an acute emergency, treatment at the closest hospital is the best option. Do not drive to the hospital; call emergency medical services, so that the point of care comes to you. The sooner qualified treatment starts, the better your chances are for survival.
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