Ischemic Heart Disease – Detailed Pathology
The blood vessels that supply oxygen and nutrients to the heart are called coronary arteries.
When these coronary arteries narrow due to atherosclerosis, it can lead to reduced blood flow to the heart, causing symptoms such as chest tightness, arrhythmia, and decreased heart function. This is called ischemic heart disease.
There are two patterns of onset in ischemic heart disease: ‘angina pectoris (chronic coronary syndrome)‘ where atherosclerosis progresses and symptoms gradually worsen, and ‘acute myocardial infarction (acute coronary syndrome)‘ where blood flow is suddenly obstructed due to thrombosis.
In addition to lifestyle habits such as smoking, lifestyle-related diseases like hypertension, diabetes, and hypercholesterolemia (dyslipidemia) damage the walls of blood vessels and cause atherosclerosis.
Atherosclerosis forms mound-like masses made of cholesterol and calcification (calcium) on the walls of arteries. This mound is called a plaque, which develops protruding into the blood flow path within the vessel, and as the disease progresses, it can obstruct blood flow.
The disease that gradually progresses from this atherosclerosis is ‘angina pectoris (chronic coronary syndrome)‘. Angina begins with symptoms such as ‘pressure in the center of the chest’ or ‘heavy pain in the center of the chest’ when the body is active, such as during jogging, climbing stairs, or walking long distances, and gradually increases in frequency and severity. This reduced coronary blood flow may not always cause the above symptoms and can progress without symptoms (in this case, it is called ‘silent myocardial ischemia’).
Additionally, this mound-like atherosclerosis (plaque) can erupt like a volcano, and its contents or the blood clot formed there can suddenly block the blood flow in the coronary artery. In such cases, chest pain occurs suddenly, even at rest, and often becomes so severe that an ambulance needs to be called. This is called ‘acute myocardial infarction (acute coronary syndrome)‘, where the heart muscle (myocardium) becomes asphyxiated, causing heart cells to die.
Acute myocardial infarction can sometimes develop into a life-threatening condition by causing fatal arrhythmias or extreme decrease in heart function, requiring immediate attention.
