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Changing Lifestyles, Changing Habits: Managing Ischemia Heart Disease?

separator You might have heard the term before—ischemic heart disease. What exactly does that mean? You might have heard the term before—ischemic heart disease. What exactly does that mean?

Cardiac ischemia results when coronary artery disease has reached the point where the heart muscle is not getting enough oxygen. An ischemic episode is most likely to occur especially during

  • Physical exertion
  • Stress
  • Eating
  • Exposure to cold
  • A combination of these factors

The most common cause of cardiac ischemia is a build-up of plaque in the artery.

You hear the term ischemia for other parts of the body as well. For example, hepatic ischemia indicates reduced blood flow to the liver, renal ischemia is reduced blood flow to the kidney and cerebral ischemia is reduced blood flow to the brain, which can cause a stroke.

Episodes of cardiac ischemia are sometimes minor, and cause little more than slight pain. But for some people, ischemia can cause such serious effects as

  • Abnormal heart rhythms, or arrhythmias, which can lead to fainting or cardiac arrest—the inability of the heart to pump blood
  • Heart attack triggered by the longer episodes of ischemia
  • Weakening of the heart muscle, or cardiomyopathy, which can result over the long-term as a cumulative effect of ischemic episodes

The location of the arterial blockage, its severity the number of blood vessels that are affected determine

Angina: the primary symptom
Episodes of cardiac ischemia often cause chest pain, pressure or discomfort called angina. It’s the primary symptom, in fact. More than 6 million Americans have angina. Angina pain varies from person to person. Some people a type of crushing pressure deep in the breastbone. For some, the pain radiates to the shoulders, arms, back, neck or jaw.

Angina pain if often the first indication of coronary artery disease. It’s actually a helpful symptom, because it lets you know that something is wrong.

Angina occurs in more women than men, and at a higher rate in African-Americans and Hispanics than in Caucasians.

Silent ischemia—no pain at all
Many people have cardiac ischemia that causes no pain at all. The American Heart Association estimates that 3 to 4 million Americans have this type of ischemia. It’s possible that they don’t feel pain because they have a lighter activity level and don’t exert themselves as much as those who do feel pain. No pain may sound like a good thing, but if these individuals don’t know they have coronary artery disease, they can have a heart attack without any warning.

Diagnosing cardiac ischemia
Doctors often use an exercise stress test combined with an EKG to diagnose cardiac ischemia. You exercise on a stationary bike or treadmill at different speeds and elevations, and the EKG measures the way the heart responds during the physical exertion.

Some doctors also use a Holter monitor to detect cardiac ischemia. You would wear this for 24 hours while an EKG monitors your heart continuously.

What’s the treatment?
There are a variety of treatments for cardiac ischemia. Sometimes, doctors prescribe medications that reduce the heart’s need for oxygen by slowing the heart rate, reducing blood pressure and relaxing blood vessels. These drugs fall into the classes known as calcium channel blockers, beta-blockers and nitrates. Aspirin therapy is also often beneficial, because it decreased the chance that a blood clot will form in the artery, which could cause a heart attack.

An exercise program is also appropriate for most patients, but people with cardiac ischemia should talk with their doctors to make sure they’re exercising safely.

Learning to manage stress is also important. Meditation, t’ai chi, qigong and other spiritual approaches can have a positive effect on the way the heart responds to stress.

If the non-invasive techniques don’t cause improvement, your doctor may recommend balloon angioplasty or bypass surgery.

How can you prevent cardiac ischemia?
The best way to prevent cardiac ischemia is to follow what’s often called a “heart healthy” lifestyle. That means

  • Eating a diet high in fruits and vegetables and low in saturated fats and sugary desserts
  • Not smoking
  • Exercising almost every day
  • Controlling your weight
  • Keeping blood pressure in the healthy range
  • Controlling diabetes, if you have it

If you already have cardiac ischemia, following a heart healthy lifestyle may help to stop the progression of the condition or even reverse it.

The American Heart Association; M. DeBakey, A. Gotto Jr. The New Living Heart. Adams Media Corporation, 1997.
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