Ischemic Heart Disease, also known as Coronary Artery Disease, is a condition that affects the supply of blood to the heart. The blood vessels are narrowed or blocked due to the deposition of cholesterol on their walls. This reduces the supply of oxygen and nutrients to the heart muscles, which is essential for proper functioning of the heart. This may eventually result in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack.
As the heart is the pump that supplies oxygenated blood to the various organs, any defect in the heart immediately affects the supply of oxygen to the vital organs like the brain, kidneys, liver, etc. This leads to the death of tissue within these organs and their eventual failure. Ischemic Heart Disease is the most common cause of death in many countries around the world.
CAUSES OF ISCHEMIC HEART DISEASE
- The major risk factors are smoking, diabetes mellitus and cholesterol levels.
- Those with Hypercholesterolemia have a much higher tendency to develop the disease.
- Hypertension is also a risk factor in the development of Ischemic Heart Disease
- Genetic and hereditary factors may also be responsible for the disease.
- Stress is also thought to be a risk factor.
- Angina pectoris
- Acute chest pain: which can be associated with acute coronary syndrome, unstable angina or myocardial infarction
- Heart failure -difficulty in breathing or swelling of the extremities due to weakness of the heart muscle
Fatty diet, smoking, sedentary lifestyle and stress should be avoided, as they are the main causes of Ischemic heart diseases. Avoiding foods rich in saturated fats is important to reduce lipid levels in the blood and to prevent arteriosclerosis. Adequate regular exercise is also essential. Cholesterol and hypertension should be kept under good control with proper treatment.
ISCHEMIC HEART DISEASE TREATMENT:
- Organic Nitrates
- Beta Blockers
- Calcium Channel Blockers
- Statins
- Aspirin
Organic Nitrates relax the nonspecific smooth muscles.
Mechanism Of Action:
NO- Nitrc oxide
GC- guanylyl cyclase
c-GMP- Cyclic GMP
Organic Nitrates stimulates the intracellular cyclic-GMP, which, results in vascular smooth muscle relaxation of both arterial and venous vasculature.
Increased venous pooling decreases left ventricular pressure (preload) and arterial dilatation decreases arterial resistance (afterload). Therefore, this reduces cardiac oxygen demand by decreasing left ventricular pressure and systemic vascular resistance by dilating arteries. Additionally, coronary artery dilation improves collateral flow to ischemic regions.
Organic Nitrate Drugs
- Isosorbide Dinitrate
- Isosorbide mononitrate
Beta Blockers act by reducing cardiac work and O2 consumption.
Mechanism Of Action:
The physiologic effects of catecholamines (norepinephrine and epinephrine) are mediated by activation of specific alpha and beta adrenergic receptors. There are three types of beta receptors. Beta blockers act by competitively inhibiting catecholamines from binding to these receptors.
Beta Blockers
- Propanolol
- Atanolol
- Timolol
Thus, Beta Blockers reduces the total coronary flow by blocking beta2 receptors.
Mechanism Of Action:
Calcium antagonist inhibits the passage of calcium ions through voltage-dependent L-type calcium channels in cell membranes in the heart and vascular smooth muscle as well as some other excitable tissues.
Calcium Channel Blockers
- Amlodipine
- Nifedipine
Ischemic heart disease is also due to the increased cholesterol levels. Statins are used to reduce the Cholesterol levels in hypercholesterolemia. Statins are the HMG-CoA Reductase inhibitors.
Statins leads to 60% decrease in the number of cardiac events (heart attack, sudden cardiac death), and a 17% reduced risk of stroke.
Mechanism Of Action:
Statins competitively inhibit conversion of 3-Hydroxy-3-methyl glutaryl coenzyme A to mevalonate by HMG-CoA Reductase.
Statins
- Atorvastatin
- Rusvastatin
Aspirin improves the rate of survival in patients with acute myocardial infarction and reduces the risk of myocardial infarction in patients with unstable angina, and after recovery from myocardial infarction.
ISCHEMIC HEART DISEASE:
4 comments:
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