Ischemic Heart Disease

Ischemic cardiomyopathy or Ischemic Heart Disease is a term that doctors use to describe patients who have congestive heart failure due to coronary artery disease.

"Ischemic" means that an organ (such as the heart) is not getting enough blood and oxygen. "Cardio" means heart and "myopathy" means muscle-related disease.

Signs and Symptoms of Ischemic cardiomyopathy or Ischemic Heart Disease

Patients with ischemic cardiomyopathy usually have symptoms of angina and heart failure.

Symptoms of angina include:

  • Chest pain that occurs behind the breastbone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the neck, jaw, back, shoulder, or arm.
  • A feeling of indigestion or heartburn
  • Dizziness or light-headedness
  • Nausea, vomiting, and cold sweats
  • Sensation of feeling the heart beat (palpitations)
  • Shortness of breath
  • Unexplained tiredness after activity (more common in women)

Symptoms of heart failure usually develop slowly over time. However, sometimes symptoms start very suddenly and are severe. Common symptoms include:

  • Shortness of breath, especially with activity
  • Shortness of breath that occurs after lying down for a while
  • Cough
  • Fatigue, weakness, faintness
  • Swelling of the abdomen (in adults)
  • Loss of appetite
  • Swelling of feet and ankles (in adults)
  • Pulse may feel irregular or rapid, or there may be a sensation of feeling the heart beat (palpitations)

Causes

Ischemic cardiomyopathy results when the arteries that bring blood and oxygen to the heart are blocked. There may be a buildup of cholesterol and other substances, called plaque, in the arteries that bring oxygen to heart muscle tissue. Over time, the heart muscle does not work well, and it is more difficult for the heart to fill and release blood.

Ischemic cardiomyopathy is a common cause of congestive heart failure. Patients with this condition may at one time have had a heart attack, angina, or unstable angina. A few patients may not have noticed any previous symptoms.

Ischemic cardiomyopathy is the most common type of cardiomyopathy in the United States. It affects approximately 1 out of 100 people, most often middle-aged to elderly men.

Risks for this condition include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • High fat diet
  • Obesity
  • Personal or family history of heart attack, angina, unstable angina, atherosclerosis, or other coronary artery diseases
  • Smoking

Diagnosis

The physical examination may be normal, or it may reveal signs of fluid buildup:

  • "Crackles" in the lungs
  • Elevated pressure in the neck vein
  • Enlarged liver
  • Extra heart sounds
  • Leg swelling

There may be other signs of heart failure.

This condition is usually diagnosed only if a test shows that the pumping function of the heart is too low. This is called a decreased ejection fraction. A normal ejection fraction is around 55 - 65%. Most patients with this disorder have ejection fractions much less than this.

Tests used to measure ejection fraction include:

  • ECG
  • Echocardiogram
  • Gated SPECT
  • MRI of chest
  • Ventriculogram performed during a cardiac catheterization

Biopsy of the heart is needed in rare cases to rule out other disorders.

Lab tests that may be used to rule out other disorders and assess the condition of the heart include:

  • Blood chemistries
  • Cardiac biochemical markers (CK-MB, troponin)
  • CBC
  • Coronary risk profile

Treatment

The goal of treatment is to relieve symptoms and treat the cause of the condition. If symptoms are severe, you may need to stay in the hospital.

A cardiac catheterization will be done to see if you can have bypass surgery or a balloon procedure (angioplasty). These treatments can improve blood flow to the damaged or weakened heart muscle.

The overall treatment of cardiomyopathies is focused on treating heart failure.

Drugs and treatments that may be used include:

  • ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril
  • Angiotensin receptor blockers (ARBs) such as losartan and candesartan
  • Diuretics, including thiazide, loop diuretics, and potassium-sparing diuretics
  • Digitalis glycosides
  • Beta-blockers such as carvedilol and metoprolol
  • Drugs that dilate blood vessels (vasodilators)

Some people may benefit from the following heart devices:

  • Single or dual chamber pacemaker
  • Biventricular pacemaker
  • Implantable cardioverter-defibrillator
  • Left ventricular assist device (LVAD)

A low-salt diet may be prescribed for adults. Fluid may be restricted in some cases. You can usually continue your regular activities, if you are able.

If you smoke or drink alcohol excessively, stop doing so. These habits increase stress on the heart.

You may be asked to monitor your body weight daily. Weight gain of 3 or more pounds over 1 or 2 days may indicate fluid buildup (in adults).

A heart transplant may be recommended for patients who have failed all the standard treatments and still have very severe symptoms. Recently, implantable, artificial heart pumps have been developed. However, very few patients are able to undergo either of these advanced treatments.

Outlook (Prognosis)

This is a very serious disorder. It is a chronic illness that usually gets worse over time. Infection and other stress on your body from other medical illnesses will also cause symptoms to get worse.

It is very important to discuss your situation with your doctor to ensure that you can improve it as much as possible. You can control symptoms of heart failure and angina with medication, lifestyle changes, and by treating any underlying disorder.

Prevention

The best way to prevent ischemic cardiomyopathy is to avoid getting heart disease.

  • Stop smoking
  • Eat a healthy diet
  • Maintain a healthy weight
  • Exercise as much as possible
  • Avoid excessive drinking
  • See your doctor to control blood pressure, cholesterol, and diabetes