The symptoms of ischemic heart disease (lHD), angina and myocardial infarction

Chest pain or angina pectoris occurs only on exertion in the mild cases; when chest pain occurs even when resting the disease is more advanced. Although "angina" means pain, some patients with th‘s condition develop only a discomfort in the central region of the front of the chest on exertion. This could take the form of a tightening, pressing or burning sensation. Pricking pain and sharp stabbirg pain is unlikely to be anginao Difliculty in breathing on exertion, and, if severe, even at rest . When the heart is failing to perform its functions adequately, patients are said to be in “heart failure”; then, in addition to difflculty in breathing on exertion, they develop swelling of the body, especially around the ankles, congestion of the liver and lungs, and find it difficult to breathe even at rest. Sometimes there is a sudden obstruction to the blood supply to the heart. This is due to damage at the site of deposits of atherosclerosis. This cuts off the blood supply to a part of the heart muscle, which will then cease to function. lf that happens, serious and sometimes fatal complications occur. This is referred to as a "heart attack" or myocardial infarction. These patients may get severe chest pain, which may radiate to the neck or arms; they are usually bathed in sweat, and find it dfficult to breathe. This is an emergency, and they have to be rushed to hospital.

Rarely, there may be no chest pain obvious difficulty in breathing; this is referred to as a "silent heart attack". Other symptoms of IHD include, undue fatigue; this could be the first symptom of ischemic heart disease in many cases, flatulence and eructations. When the lower part of the heart which touches on the diaphragm - the muscular wall that separates the chest cavity from the abdomen - is affected, the symptoms can be mainly “gastric”. Most persons think that they are suffering from gastric acidity; in fact, the symptoms are indistinguishable. Left sided chest pain which is pricking or gnawing in nature is rarely a symptom of heart disease. Pain in the area of the left nipple region is generally of muscular origin. Also, chest pain, which is fleeting, i.e lasting only a few seconds like a flash of lightning is not a symptom of ischemic heart disease.

Investigations and treatment

Investigations such as ECG, chest X-ray, Echo-cardiograph, cath lab studies - angiogram, blood tests (ESR, SGOT,Troponin) are helpful in the management of both IHD and myocardial infarction. A test, troponin gives an accurate indication of damage to the heart muscle. Lipid profile and C reactive proteins are useful in the long term management. Treatment is best undertaken by a physician experienced in heart disease. An injection streptokinase is given within 6 hours of a heart attack to dissolve the clot; early administration of streptokinase has reduced the fatality rate. In recent times cardiologists have developed measures to restore the blood supply to the heart by sophisticated forms of therapy, such as angioplasty, which is a skilled technique by which a catheter is introduced through a blood vessel in the periphery to the site of the narrowing or blockage (in the coronary artery) which has been predetermined by an angiogram done earlier; then the diseased segment of the artery is dilated, usually by a process of "ballooning" it ; however it is reported that there is a high rate of recurrence, about 30%, within a period of 6 months. Coronary bypass is also a major surgical operation where blood vessels from a different part of the body are used to bypass the block. This major surgery would give a new lease of life.

Chelation therapy is claimed to reverse and/ or slow the process of atherosclerosis. The treatment consists of a series of intravenous injections of an amino-acid, called EDTA. It is being used to clear blocked arteries, such as those of the heart, brain and legs. its mode of action is not yet fully understood. Though it is certainly less expensive than angioplasty or bypass surgery. It is still only in an experimental stage. Soluble aspirin daily (dose,1/2 tablet: 1 tab is 300mg), which is known to prevent the risk of clotting of blood over the deposits in the arteries is used in the long term prevention of IHD.