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The word ischemia means lack of blood supply. Ischemic heart disease is a condition in which one or more regions of the heart receive less blood than normal.

The blood supply of the heart is maintained by two coronary arteries, namely, the left and right coronary arteries.

In some patients, a type of fatty substance known as cholesterol gets deposited in one or both coronary arteries. Such deposits hamper the flow of blood, so that there are areas of the heart that get less blood than normal. These areas are, therefore, ischemic.

People who have hypertension, diabetes mellitus, hypothyroidism, and chronic kidney disease have abnormalities in the endothelial cells that line the lumen of the coronary arteries. This makes them susceptible to cholesterol deposition.

People who take large amounts of fatty food such as ghee, butter, and red meat have high blood levels of cholesterol. Some of the excess circulating cholesterol gets deposited in the coronary arteries.

Other people have a bad family history. Genetic factors are believed to be responsible in these subjects.

Angina pectoris (angina= pain; pectoris= chest) is the hallmark of patients who suffer from ischemic heart disease. Surprisingly, the majority of people deny having pain. The latter describe their feelings as a sense of crushing, squeezing, or oppression.

The discomfort starts in the center of the chest. It may spread to the left or right sides of the chest, to the back of the chest in between the shoulder blades, to the front of the neck and/or lower jaws, and to the inner aspect of the left arm.

The discomfort is brought about by brisk exercise such as walking or climbing up the stairs, and is frequently noticed during walking after heavy meals. Quiet standing, sitting, or lying down usually relieves the symptoms.

Angina pectoris is a potential threat to the life and well-being of human beings, and the sufferers should seek the advice of a cardiologist as soon as possible. Many valuable lives have been lost because the patients or their relatives have been late in going to a specialist.

Some symptoms indicate that the patient’s ischemic heart disease is worsening. These are: Discomfort occurring at a lower level of activity than before, change in the nature and quality of discomfort, and discomfort which lasts for twenty minutes or more and does not get relieved after taking emergency medication.

There are different types of tissue in the chest of a human being, and each of these tissues can give rise to chest discomfort. It can be a consequence of disease in the muscles, bone, cartilage, skin, lungs, food pipe (esophagus), or blood vessels (aorta).

The diagnosis of ischemic heart disease falls within the domain of the super-specialist, so that most family physicians do not take chances. They usually refer the patient to a cardiologist. In addition, most surgeons and gastroenterologists will refer their elderly patients with abdominal pain to cardiologists to rule out ischemic heart disease.

Under no circumstances should the patients or their attendants try to make a cardiac diagnosis by guess work, or by consulting the internet.

Investigations should be individualized depending on the requirements of a particular patient.

However, the following tests are required for most subjects: Fasting and post-prandial blood sugar, lipid profile, SGPT, creatinine, sodium, potassium, complete blood count, ECG, and echo Doppler test. Many patients will also require a treadmill test.

They should take a diet that contains less of saturated fat (such as ghee or butter) and more of poly-unsaturated fatty acids (such as groundnut oil, sunflower oil, and soybean oil). Extra virgin olive oil is very good, but it is beyond the reach of most Indian households because of the excessive cost.

The diet should contain liberal quantities of green vegetables and herbs, sufficient fruits, and low-fat milk. Fish, especially large ocean fish, is beneficial. Moderate amounts of lean poultry meat can be allowed.

All forms of tobacco are poisonous and should be strictly avoided.

Alcohol has a tremendous abuse potential; many people cannot stop drinking. For people who do not drink, we do not recommend that they start drinking. For people who drink, we strongly advocate moderation.

The platelets of patients of ischemic heart disease have a tendency to adhere to the walls of the arteries. Such adherence is harmful because they lead to clot formation, and hence, heart attacks.

Blood thinners such as aspirin and/or clopidogrel reduce the stickiness of the platelets, and hence, facilitate the forward flow of blood. They are, therefore, useful in reducing the incidence of heart attacks.

Until a few years ago, most cardiologists were prescribing statins in doses (such as 10 mg/day) which were small compared to the present day standards (40-80 mg/day).

Recent guidelines have recommended administration of atorvastatin 80 mg/day irrespective of the blood levels of cholesterol. This reduces the cholesterol to subnormal levels in nearly all people. It is well tolerated and beneficial for nearly everyone.

Most specialists in India are scared to prescribe 80 mg/day because the average body weight of the Indian subjects is lower than that of their peers in the USA. They commonly advise 40 mg/day.

Certainly not. The decision to advise angioplasty or bypass surgery is taken after taking into consideration the clinical background and the investigation results.

Angioplasty or bypass surgeries are highly beneficial when they are done for the right indications. They not only relieve the patients of the distressing chest discomfort, but reduce the threat of heart attacks and allow them to live longer.