Health Tips

Leading death cause in Malaysia—Ischemic heart disease

According to Department of Statistics Malaysia 2021, ischemic heart disease remained as the leading cause of death in both men and women, with 17% of the 109,155 medically certified deaths in 2020 (19.3% out of 65,918 deaths for male; 13.4% out of 43,237 deaths for women).

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What is ischemic heart disease?

Ischemia: Insufficient blood supply to a body part due to blockage of the blood vessels supplying to the organ

Ischemic: Condition in which an organ is not getting enough blood and oxygen due to restricted blood flow

Ischemic heart disease, also known as coronary heart disease, is where the heart muscle does not get enough blood and oxygen due to narrowed blood vessels. This can eventually lead to major heart attack if left untreated.

Although the narrowing can be caused by a blood clot or by the constriction of the blood vessel, most of the time it is caused by a buildup of cholesterol plaques.

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How do you know if you have ischemic heart disease?

Many people with ischemic heart disease have no symptoms. For those who do, the most common symptoms usually happen with exercise and physical exertion. This is because when we exercise,  our body requires more oxygen supply mainly to the muscle. Due to the blockage in the blood vessels, the heart now needs to pump the blood harder so that it is able to supply adequately, matching the demands of the body. The abnormal narrowing of the supplying vessels to the heart, is referred to as angina, whereby it can result in symptoms such as: 

• Pain, pressure, heaviness or discomfort in the center of the chest

• Pain, tingling or discomfort in other parts of the upper body, including the arms, back, neck, jaw or stomach

• Having difficulty in breathing 

Over time, ischemic heart disease may slowly progress into heart attack, whereby the blood supply to the heart muscles are completely cut off, resulting in heart muscles to die off. If severe enough, this can lead to death. People suffering from heart attack may experience symptoms as shown in the picture below.

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If these symptoms last more than 10 minutes or they are increasing in intensity, call for an ambulance immediately. Do not try to get to the hospital on your own.

Tests for ischemic heart disease

Further confirmation is necessary based on the symptoms you have experienced. Therefore, doctor might order for further tests like blood tests and others. 

1. An electrocardiogram (ECG)

This test measures the electrical activity in your heart and able to show any early signs and abnormalities in relation to the heart.

2. A stress test or exercise stress test

As the name suggests, you might be asked to run or walk on a treadmill while you having an ongoing ECG monitoring. As mentioned above, exercise requires extra oxygen supply, and this test essentially helps doctor to gauge the severity of the blockage, if there is any. see if the heart is getting enough blood. 

However, if you are not able to run or walk due to other condition like osteoarthritis, the doctor might give you medication that will make your heart pump faster for this test.

3. An echocardiogram

Simply put, this test is like an ultrasound of the heart, which uses sound waves to create an image of your heart as it beats rhythmically. This test is able to generate various information regarding the overall health of the heart, valve function, the size of each heart chamber and much more. 

4. Cardiac catheterization (also called “angiogram”) 

This is an invasive procedure, which will be advised by your doctor if your symptoms and clinical parameters are suggestive of an ischemic heart disease. During this test, the doctor will insert a thin tube into a blood vessel in your leg or arm, moving all the way up to the heart. Next, a dye will be injected through the catheter into vessels, and images of the heart arteries are taken (this part of the test is called “coronary angiography”). This test enables us to objectively tell us if there are any of the arteries in your heart that are clogged.

How is ischemic heart disease treated?

1. Lifestyle modifications

Good lifestyle habits reduce the risk of heart attack and death. This includes:

• Quit smoking, if you do. Smoking is believed to constrict blood vessels which may further worsen your current condition.

• Eat lots of fruit, vegetables and foods with a lot of fiber. The picture below shows the balanced food portion practiced by Malaysians recommended by MOH Malaysia.

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You may also practice DASH diet in order to achieve a balanced meal daily.

• Exercise 

It is recommended to exercise 150 minutes per week, which can be divided into 30 minutes for 5 days. You may start with light exercise such as walking or jogging.

2. Medications 

After being diagnosed with ischemic heart disease, your doctor may prescribe you with some life-long medications to reduce the risk of you getting a severe heart attack and can help you live longer. The key is to take medications every day as directed. Medications that your doctor might prescribe are:

• Statins, to lower blood cholesterol

• Medications to lower blood pressure, if you are found to be have high blood pressure

• Aspirin or other blood thinners that help prevent blood clots

• Medications to treat diabetes, if any you are found to be having uncontrolled blood sugar levels

• Nitrates, to treat chest pain, if any

3. Surgery

Some people with ischemic heart disease can also have:

• A stent procedure

During this procedure, doctor inserts a thin plastic tube into the blocked blood vessel then uses a tiny balloon to open the blockage.Subsequently, the doctor can choose to leaves a tiny mesh tube called a “stent” inside the artery to keep it open.

• Bypass surgery (also known as “coronary artery bypass surgery” or CABG)

During bypass surgery, the doctor removes a piece of blood vessel from other part of the body such as the leg, then re-attach the blood vessel over the heart above and below the area that is clogged. This re-routes blood flow around the clotg and allows it to get to the part of the heart that was not getting blood initially.

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All in all

Ischemic heart disease can easily cause sudden death, hence it is important to detect and be cautious of the early signs of ischemic heart disease. In ischemic heart disease, the heart damage might be reversible but once it has developed into heart attack, the damage is most often irreversible. Visit a doctor right away if you have chest pain that is new, severe or different from any pain you have had before in the past.

Medically reviewed by Ashwini Nair, MB BCh BAO.

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References:

1. Chronic coronary syndrome: Overview of care - UpToDate. Accessed April 2, 2022. https://www.uptodate.com/contents/chronic-coronary-syndrome-overview-of-care?search=ischemic%20heart%20disease&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1
2. Patient education: Coronary artery disease (The Basics) - UpToDate. Accessed April 2, 2022. https://www.uptodate.com/contents/coronary-artery-disease-the-basics?search=ischemic%20heart%20disease&topicRef=1483&source=related_link#H4679769
3. Criteria I of M (US) C on SSCD. Ischemic Heart Disease. National Academies Press (US); 2010. Accessed April 2, 2022. https://www.ncbi.nlm.nih.gov/books/NBK209964/

Written By

DOC2US Editorial Team

Reviewed By

Doc2us Medical Board