Ischemic Heart Disease: Symptoms & Treatments
Angina pectoris is the hallmark of
ischemic heart disease.
Characterized by pain or discomfort in the chest, which often radiates through the upper extremities, face, and other areas of the body, and is due to the heart's inability to meet its metabolic needs.
Stable angina is characterized by predictable triggers, duration, and frequency.
Unstable angina is unpredictable and is a medical emergency, as it can lead to
myocardial infarction.
Non-ischemic causes of angina include aortic stenosis, anemia, arrhythmias, and hypertrophic cardiomyopathy.
Other indicators of Ischemic Heart Disease include discomfort or pain in other areas of the body, fatigue, etc.
These symptoms are sometimes described as "atypical angina," or "angina equivalents."
Silent ischemia refers to asymptomatic ischemic heart disease; be aware that "silent" does not mean "harmless," and silent ischemia is associated with increased morbidity and mortality.
Diagnosis of ischemic heart disease may involve ECG, echocardiogram, stress testing, angiograms, and CT scans.
Although angina is often due to
obstructive coronary artery disease, angina can also occur in the absence of clinically significant blockage.
Stable angina
Sometimes called "effort" angina because it is triggered by physical or mental exertion, such as climbing a flight of stairs or a psychologically stressful event.
This type of angina resolves with rest and/or nitrates.
Unstable angina
New onset or worsening angina that is unpredictable; it occurs spontaneously during activity or rest, and does not resolve with rest or medications.
Unstable angina is a form of
acute coronary syndrome, and, as mentioned earlier, is a medical emergency that can lead to
myocardial infarction.
Vasospastic angina
Also known as
variant and Prinzmetal angina
Occurs when vasospasm contracts the vessel and reduces blood flow.
Occurs
spontaneously, and often at rest.
A hallmark of vasospastic angina is occurrence at
night or early morning – early morning exercise is a common trigger.
Vasospastic angina is most common in women and cigarette smokers.
Responds to nitrates, and can be suppressed by calcium-channel blockers (but not beta-blockers, which can exacerbate this type of angina).
Microvascular angina
This is the result of
coronary microvascular dysfunction or vasospasm.
Microvascular angina accounts for chest pain in up to half of patients who do not have obstructive coronary artery disease.
Occurs with
exertion and at rest, but, may respond less well to nitrates.
- Difficult to distinguish from epicardial angina, and, that positron emission tomography (PET) or cardiac magnetic resonance (CMR) can be used to assess coronary microvascular blood flow.
Common Symptoms of Ischemic Heart Disease
Sex, age, and race may influence which symptoms are present and how they are interpreted.
Angina
Many patients experience chest discomfort or pain, which is variably described as: tightness, dull, sharp, or stabbing pain, squeezing, or pressure on the heart.
We show the patient displaying
Levine's sign, a clenched fist held over the sternum, because many patients will describe their chest discomfort with this gesture or one similar to it.
Patients also report
discomfort in the shoulders, arms, neck, and jaw; pain is often described as "radiating".
Other S/Sx:
Some patients, particularly those of African descent, often experience
gastrointestinal discomfort that may be interpreted as indigestion or heart burn, abdominal pain or burning.
Thus, practitioners should consider ischemic heart disease in patients who report such symptoms when gastrointestinal causes are ruled out.
Some patients, especially women with ischemic heart disease, experience
light-headedness or dizziness, and persistent fatigue.
Other commonly-reported symptoms include
dyspnea (difficulty breathing) and
excessive sweating.
