Disease Description (Causes and Symptoms)
- Disease name: Ischemic heart disease — this is a medically appropriate term. Synonyms: ischemic heart disease, ischemic cardiac disease. Related categories: stable/unstable angina, acute myocardial infarction (AMI).
- Definition and pathophysiology: Occurs when the myocardium receives an insufficient supply of blood and oxygen due to coronary artery atherosclerosis or thrombosis. Symptoms are likely to occur when the coronary artery lumen is narrowed by approximately 70% or more; if complete occlusion persists without reopening (generally within several hours), myocardial necrosis occurs. The high-risk period after acute myocardial infarction is approximately 3 days to 1 week after onset, when the risk of complications (arrhythmia, heart failure) is high.
- Major causes: Coronary artery atherosclerosis (smoking, hypertension, diabetes, hyperlipidemia, family history, advanced age, etc.), coronary artery spasm, embolism, inflammation, dissection, etc.
- Major symptoms: Chest pain (center of the chest or a feeling of pressure), radiating pain (neck, jaw, left arm, etc.), shortness of breath, cold sweats, nausea and vomiting, syncope or dizziness. Ischemia is triggered by activity or stress (the triggering conditions are clear in stable angina), while unstable angina/myocardial infarction may also occur at rest.
- Related complications (summary): Arrhythmia (fatal ventricular arrhythmia), heart failure, pericarditis, cardiac rupture, cardiogenic shock, thromboembolism.
Treatment Methods
- Acute phase (first aid when suspected)
- First aid: Prompt 12-lead electrocardiogram evaluation, oxygen therapy (in cases of hypoxia), immediate administration of aspirin (initial antiplatelet therapy), nitrates (monitor for adverse effects), pain control (if necessary), and anticoagulants in high-risk patients.
- Reperfusion treatment: In ST-segment elevation myocardial infarction, coronary intervention (PCI) should be performed as quickly as possible (target reperfusion time within 90–120 minutes), or thrombolysis depending on access to the hospital (when permitted). Coronary artery bypass grafting (CABG) is considered for extensive lesions or multivessel disease.
- Drug treatment (acute and chronic)
- Antiplatelet agents: Aspirin (standard), P2Y12 inhibitors (clopidogrel/prasugrel/ticagrelor) — the duration of dual antiplatelet therapy (DAPT) is determined according to the type of stent and risk level.
- Anticoagulants: Used depending on the situation (e.g., during PCI or for special indications).
- Beta-blockers: Reduce myocardial oxygen demand and prevent arrhythmia.
- Nitrates: Relieve angina (short-acting and long-acting).
- High-intensity statins: Secondary prevention through strong reduction of LDL.
- ACE inhibitors/ARBs: Recommended in cases of reduced cardiac function (low EF) or coexisting hypertension or diabetes.
- Aldosterone antagonists: Provide a survival benefit in patients with heart failure and low EF.
- Procedures and surgery
- PCI (stent placement): Primary treatment for coronary artery stenosis (preferred in acute MI).
- CABG: Considered for left main coronary artery or complex multivessel disease, diabetes, etc.
- Rehabilitation and chronic management
- Cardiac rehabilitation: Gradual exercise program, risk-factor modification, and education.
- Lifestyle measures: Smoking cessation, weight control, regular exercise (as directed by a doctor), a low-salt, low-saturated-fat diet, and strict control of blood pressure, blood glucose, and lipids.
- Precautions
- Oxygen should be used only in patients with hypoxia (SpO2 < 90%); avoid excessive use.
- Bleeding risk must be managed while taking antiplatelet agents or anticoagulants.
- Adherence to DAPT after stent placement is important (the duration is determined by balancing bleeding and ischemic risks).
- Prognosis
- Varies depending on the extent of the lesions, size of myocardial necrosis, speed of initial reperfusion, and comorbidities. Prognosis can be improved through early reperfusion, standard drug treatment, and rehabilitation.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare (recommended to bring)
- List of currently prescribed medications (including doses and administration times) and allergy information
- Previous test results (recent electrocardiogram, echocardiography, coronary angiography/PCI/surgical records, blood tests [lipids, glycated hemoglobin, etc.])
- Symptom record: time of onset and duration, triggers (exercise, meals, emotions), relieving factors (rest, nitrates), and accompanying symptoms (shortness of breath, syncope)
- Changes in daily life (amount of exercise, smoking and alcohol use, weight changes)
- Blood pressure, heart rate, and home measurement records (if available)
- Show the doctor directly during the outpatient visit
- Stent placement or cardiovascular surgery records (surgical records, if possible)
- Previous emergency department or hospitalization records (in the case of myocardial infarction)
- Example questions to check before the visit (organize in advance)
- When and how did the symptoms begin?
- In what situations do they worsen or improve?
- Location and intensity of the pain (0–10), and whether it radiates
- Have any medications recently been changed or discontinued?
General Example Questions to Ask the Doctor
- What are the main side effects of this medication (or these medications), and what drug interactions should I be aware of?
- How well is my heart functioning (e.g., left ventricular ejection fraction [EF]), and what is my prognosis?
- When can I begin exercising, and at what level? When can I return to work or drive?
- What lifestyle change should I make first to reduce the risk of recurrence?
Examples of Condition-Specific Questions
- Where is my coronary artery stenosis located and how severe is it (e.g., what percentage of narrowing in which vessel), and what treatment is recommended accordingly (is medication alone sufficient, or is PCI or CABG necessary)?
- How long should dual antiplatelet therapy (DAPT) be continued after stent placement (or PCI)? How should it be adjusted if there is a risk of bleeding?
(Emergency symptoms: Persistent and severe chest pain, loss of consciousness, sudden shortness of breath, severe sweating, nausea, dizziness, etc. require an immediate visit to the emergency department or a call to 119.)