P.1
Definition of ischemic heart diseases.
A condition in which the coronary arteries, which supply blood to the heart muscle, are narrowed or blocked, impeding the flow of blood to the heart muscle and causing oxygen deficiency in the heart muscle.
Diseases included in ischemic heart disease
・angina pectoris
・Aortic aneurysm
・Myocardial infarction... etc.
P.2
Lecture Outline
This lecture will focus on angina pectoris, the earliest stage of ischemic heart disease.
What we learn
・Outline of angina pectoris
・Types of angina pectoris
・Cause
・Risk factor
・Clinical signs
・Signs/early symptoms
・Diagnosis
・Treatment
・ Prevention strategy guidance (for patients who have not developed symptoms)
・Preventive strategy guidance (for patients who have already developed symptoms and are receiving treatment)
P3
・Outline of angina pectoris
Angina pectoris is a disease in which the blood supply to the heart is interrupted for some reason, causing chest pain at various times (1Mayo Clinic Staff, 2022).
・Cause
There are three main types of angina pectoris, and the common causes are lifestyle-related diseases such as dyslipidemia, hypertension, and diabetes. It is often caused by the narrowing of blood vessels by fatty deposits called plaque. (atherosclerosis)
Figure(Carson-DeWitt, n.d.)
P4
Types of Angina
1. Stable angina
Low-to-Moderate chest pain occurs during exercise or in cold environments and mostly resolves within 5 minutes (1Mayo Clinic Staff, 2022).
2. Unstable angina
Unstable angina is unpredictable and occurs during unstressed rest (1Mayo Clinic Staff, 2022). More severe chest pain, lasting more than 20 minutes, can cause the heart to starve of oxygen and, if not urgently treated, can lead to a heart attack and, in extreme cases, death.
3. Variant angina
It is caused by temporary spasms of the coronary arteries, constricting them and reducing blood flow. Patients experience severe chest pain at rest and night (1Mayo Clinic Staff, 2022).
P5
Risk factors (related to lifestyle)
・Lack of exercise and obesity
It causes dyslipidemia and diabetes, and leads to plaque formation and narrowing of blood vessels. Obesity also places a heavy burden on heart function.
・Smoking/Drinking
Associated with arterial damage (1Mayo Clinic Staff, 2022).
・High blood pressure
Hypertension accelerates arterial stiffening and promotes arterial damage (1Mayo Clinic Staff, 2022).
・Stress
Stress increases blood pressure, which accelerates arterial stiffness and promotes arterial damage. It has also been shown that stress affects amygdala activity and induces intravascular inflammation through factors such as sympathetic nerve activity, hormones, and cytokines (Tawakol et al., 2017).
P6
Risk Factors (unrelated to lifestyle)
・Aging
The risk of angina pectoris increases with age (1Mayo Clinic Staff, 2022).
・Family History
Patients are genetically more likely to develop angina if their parents or siblings have had heart disease or a heart attack (Wahrenberg et al., 2020).
・Medicines
Migraine treatments like sumatriptan or decongestants that contain ephedrine can cause variant angina (Cleveland Clinic medical professional, 2021).
・Low Temperature
When the body is exposed to cold temperatures, blood vessels can spasm (1Mayo Clinic Staff, 2022).
P.7
Initial Symptoms
Initial symptoms of angina pectoris is pain and discomfort in the chest and back, which patients themselves may mistake for discomfort or stomach pain due to indigestion. Patients may also experience pain in the arms, neck, jaw, and shoulders due to radiating pain (1Mayo Clinic Staff, 2022). If a patient complains of persistent abdominal discomfort or extrathoracic pain, angina should be considered.
Figure(Carson-DeWitt, n.d.)
P8
Diagnosis
・Electro-cardiogram
In patients with angina pectoris, the ECG waveform shows that blood flow through the heart is slowed or interrupted (2Mayo Clinic Staff, 2022).
・Chest X-ray/CT/MRI
Detailed images of heart structures and blood vessels are generated to diagnose whether the heart is enlarged or whether the heart's arteries are narrowed.
・Cardiac echo
Using sound waves to watch blood flow through the heart (2Mayo Clinic Staff, 2022).
・Coronary angiography
A catheter is passed through the patient's blood vessel and into the heart's artery, and a contrast medium is injected into the blood vessel to observe the inside of the artery. At the same time as the examination, the jointed blood vessel may be expanded using a balloon.
P.9
Treatment
・Medicational approach
Nitrates such as nitroglycerin relax and widen blood vessels, improving blood circulation (2Mayo Clinic Staff, 2022). Aspirin and other antithrombotic drugs reduce the risk of heart attack by reducing blood clotting and preventing blood clots (2Mayo Clinic Staff, 2022). It may also be used with medications to treat high blood pressure and diabetes.
・Surgical approach
Catheterization, in which a catheter is threaded through a patient's blood vessel into an artery of the heart and a balloon is expanded at the constricted defect to relieve the stenosis or blockage/ and there is coronary artery bypass surgery to replace the narrowed vessel (2Mayo Clinic Staff, 2022).
P.10
Prognosis
43.5% of angina patients experience hospitalization and undergo some surgical treatment. However, the prognosis is relatively unfavorable because the majority of patients with ischemic heart disease are adults or the elderly, and associated diseases such as hypertension become more challenging to treat and control with age (Lipinska & Zielinska, 2017).
P11
Preventive guidance to patients (for patients who have not developed symptoms)
・Eating healthy and exercising regularly
・Restrictions on smoking and alcohol
・Do not accumulate stress
・Treatment of lifestyle-related diseases
・Taking screening regularly
P12
Preventive guidance to patients (for patients who have already developed symptoms and are receiving treatment)
・Healthy eating and weight loss
・Restrictions on activities that put a strain on the heart
・Restrictions on smoking and alcohol
・Observance of medication instructions
・Taking screening regularly
・Consider surgical treatment
P.13
CONCLUSION
Ischemic heart disease refers to a condition in which the coronary arteries, which supply blood to the heart muscle, are narrowed or blocked, impeding the flow of blood to the heart muscle and causing oxygen deficiency in the heart muscle. Angina pectoris is an early stage of ischemic heart disease that, if not adequately treated, can lead to myocardial infarction, heart attack, heart failure, and death.
Ischemic heart disease is difficult to cure completely, and patients must continue their daily lives while coping with it. Therefore, to improve the prognosis and QoL of patients and protect their lives, it is essential to control the disease and prevent myocardial infarction, heart attack, and heart failure.
P.14
References
Carson-DeWitt, R. (n.d.). Angina. Retrieved December 15, 2022, from https://www.cancercarewny.com/content.aspx?chunkiid=12056
Cleveland Clinic medical professional. (2021). Prinzmetal angina: Causes, symptoms & treatment. Cleveland Clinic. Retrieved December 15, 2022, from https://my.clevelandclinic.org/health/diseases/21867-prinzmetal-angina
Lipinska, A., & Zielinska, M. (2017). Prognosis of angina pectoris. European Society of Cardiology. Retrieved December 15, 2022, from https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Prognosis-of-angina-pectoris
1Mayo Clinic Staff. (2022). Angina - Symptoms & causes. Mayo Clinic. Retrieved December 15, 2022, from https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373
2Mayo Clinic Staff. (2022). Angina - Diagnosis & treatment. Mayo Clinic. Retrieved December 15, 2022, from
https://www.mayoclinic.org/diseases-conditions/angina/diagnosis-treatment/drc-20369378
Wahrenberg, A., Magnusson, P. K., Discacciati, A., Ljung, L., Jernberg, T., Frick, M., Linder, R., & Svensson, P. (2020). Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients. European heart journal. Acute cardiovascular care, 9(7), 741–747. Retrieved from https://doi.org/10.1177/2048872619853521
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