Ischaemic heart disease

Ischaemic heart disease (IHD), or myocardial ischaemia, is a disease characterized by ischaemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, and hypertension (high blood pressure), and is more common in men and those who have close relatives with ischaemic heart disease.

Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest or rapidly worsening angina. Diagnosis of IHD is performed using data of an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABS).

The medical history distinguishes between various alternative causes for chest pain (such as dyspepsia, musculoskeletal pain, pulmonary embolism). As part of an assessment of the three main presentations of IHD, risk factors are addressed. These are the main causes of atherosclerosis (the disease process underlying IHD): age, male sex, hyperlipidaemia (high cholesterol and high fats in the blood), smoking, hypertension (high blood pressure), diabetes, and the family history.

Ischaemic heart disease may be present with any of the following problems: angina pectoris (chest pain on exertion, in cold weather or emotional situations); acute chest pain: acute coronary syndrome, unstable angina or myocardial infarction (" heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage) and heart failure (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle).

In " stable" angina, chest pain with typical features occurring at predictable levels of exertion, various forms of cardiac stress tests may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), echocardiography (using ultrasound of the heart) or scintigraphy (using uptake of radionuclide by the heart muscle). If part of the heart seems to receive an insufficient blood supply, coronary angiography may be used to identify stenosis of the coronary arteries and suitability for angioplasty or bypass surgery.

Diagnosis of acute coronary syndrome generally takes place in the emergency department, where ECGs may be performed sequentially to identify " evolving changes" (indicating ongoing damage to the heart muscle). This process usually necessitates admission to hospital, and close observation on a coronary care unit for possible complications (such as cardiac arrhythmias - irregularities in the heart rate).

Various treatments are offered in people deemed to be at high risk of coronary artery disease. These include control of cholesterol levels in those with known high cholesterol, smoking cessation, and control of high blood pressure. In stable IHD, antianginal drugs may be used to reduce the rate of occurrence and severity of angina attacks. Revascularization for acute coronary syndrome has a significant mortality benefit. Recent evidence suggests that revascularization for stable ischaemic heart disease may also confer a mortality benefit over medical therapy alone.

Treatment of coronary artery disease includes addressing " modifiable" risk factors. This includes suppression of cholesterol (usually with statins), even in those with statistically normal cholesterol levels, control of blood pressure, blood sugars (if diabetic), regular exercise and a healthy diet. Smokers are encouraged to stop smoking.

Exercise 6. Answer the following questions:

1. What is ischaemic heart disease?

2. What factors may cause cardiac ischemia?

3. What are the symptoms of ischemia?

4. What diseases may develop in case of cardiac ischemia?

5. What is the sequence of physician's actions for the patient with ischemia suspected?

6. What analyses are necessary to establish the diagnosis of ischemia?

7. What is the treatment of ischemic heart disease?

8. What diseases may diseases accompany ischemia?

Exercise 7. Angina is a symptom of coronary heart disease. Match the types of angina and its definitions:

Exercise 8. Complete the following sentences choosing suitable words from the box:

1. Over 83 per cent of people who ………… of coronary heart disease are 65-year-old individuals or older.

2. At older ages, women who have heart attacks are more …………… than men to die of them within a few weeks.

3. Children of parents with heart disease are more likely to ……. it themselves.

4. Smokers' ………… of developing coronary heart disease is 2-4 times that of nonsmokers.

5. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease; smokers have about ………….. the risk of non-smokers.

6. High blood pressure …………… the heart's workload, causing the heart to thicken and become stiffer. It also …………. your risk of stroke, heart attack, kidney failure and congestive heart failure.

7. People who have …………… body fat - especially if it is at the waist - are more likely to develop heart disease and stroke even if they have no other risk factors.

8. Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose (blood sugar) levels are under ……………, diabetes increases the risk of heart disease and stroke, but the risks are even higher if blood sugar is not well controlled.

Exercise 9. Choose the proper continuation:

a) Coronary ischaemia…

b) Angina pectoris…

c) Atherosclerosis…

d) Myocardial infarction….

e) The diagnosis of ischaemia…

f) It is possible to prevent the ischaemic condition by….

g) Coronary bypass surgery….

h) The treatment of ischaemic conditions…

1. ….is the most common cause of death in most Western countries and a major cause of hospital admissions.

2. …unlike the angina, is an irreversible condition.

3. ….may be expressed by chest discomfort and associated symptoms precipitated by some activity (running, walking, etc.) with minimal or non-existent symptoms at rest.

4. …is established on the basis of the case history, ECG and angiography results.

5. …improves the chances of survival of patients who are at high risk.

6. …is a disease of large and medium-sized muscular arteries and is characterized by endothelial dysfunction, vascular inflammation, and the build-up of lipids, cholesterol, calcium, and cellular debris within the lining of the vessel wall.

7. ….control of cholesterol levels in those with known high cholesterol, smoking cessation, and control of high blood pressure.

8. ….includes addressing " modifiable" risk factors, like suppression of cholesterol.

Exercise 10. Match the synonyms:

Exercise 11. What symptoms are common for the heart diseases? The suggestions on the right may help you to answer. Make sentences of your own:

Exercise 12. Arrange the following sentences according to the following two columns:

1. Calcium channel blockers and/or beta-blockers;

2. Lifestyle changes;

3. Nitroglycerin;

4. ACE inhibitors, which treat hypertension and may lower the risk of recurrent myocardial infarction;

5. Medical treatment - drugs (e.g. cholesterol lowering medications, beta-blockers, nitroglycerin, calcium antagonists, etc.);

6. Coronary artery bypass grafting (CABG);

7. Statins, which reduce cholesterol, reduce risk of coronary disease;

8. Coronary interventions as angioplasty and coronary stent

Exercise 13. Fill in the gaps with the correct word:

1. The principal cause of the ischemic heart disease is the reduction of the ………… of blood which the arteries provide for the heart to function at normal parameters. (amount / size)

2. The ischemia starts by some fatty ……….. built up in the cells of the wall which surrounds the coronary arteries (the main source of blood for the heart). (deposits / lipids)

3. The fat grows step by step into large twigs of the coronary arteries, process called ………… which brings about the narrowing of the coronary arteries which supply the heart muscle. (atherosclerosis / stroke)

4. A heart attack ………….. when the blood vessels are completely closed. Ischemia refers to an insufficient amount of blood. (feels / occurs)

5. At the beginning the coronary arteries or even their branches are becoming ………… or they are closed because of the debris flowed into the blood, which is referred to as an angina. (thick / narrow)

6. ………… ischemia is very concerning in patients with diabetes because due to without any warning signs patients don't consult the doctor. (loud / silent)

7. Ischemic heart disease doesn't have exact known causes, but there are certain ………….. that must be taken into consideration as for example age, heredity, smoking, diabetes or obesity. (risk factors / risk events)

8. The lethal symptom of ischemic heart disease is sudden death also known as massive heart attack and it is caused by an abnormal heart ………….., ventricular fibrillation that prevents the heart from contracting and pumping oxygenated blood to the brain and vital organs. (rhythm / stage)

Exercise 14. Fill in the gaps with correct prepositions:

1. When there is a reduction………..blood flow to the heart of a person, then it may be a sign…………ischemic heart disease which is, in fact, a major health concern……….much……….the western world.

2. In any person, regardless of diet or native land, it is natural plaque to build ………… along the walls of arteries.

3. For some, this never becomes an issue and they lead a normal life …….. average length.

4. However, ………. some, there can be a resulting problem which is called arteriosclerosis.

5. The one good thing ……… ischemic heart disease is that the medical field knows what the cause is, which means something can be done to avoid the problem.

6. There are simple things that those ……… risk of or who have ischemic heart disease can do: stop consuming high saturated fat foods, avoid smoking, and exercise regularly.

7. ……….. other words, leading a healthy lifestyle can help you avoid heart disease.

8. Foods high ……… saturated fats will cause more the plaque your system that builds up on the walls of arteries.

9. ………. avoiding these foods as much as possible, you are a avoiding the material that is used to block arteries.

10. Secondly, exercise will make your heart more efficient and allow your body to consume the fats you do take.

Exercise 15. Translate the following sentences into English:

1. Ішемічна хвороба серця (IXC) – це патологічний стан, що характеризується абсолютним або відносним порушенням кровопостачання міокарда внаслідок ураження коронарних артерій серця.

2. Відповідно до сучасної класифікації ІХС виділяють такі її клінічні форми: стенокардія, інфаркт міокарда, порушення серцевого ритму, серцева недостатність, раптова коронарна смерть.

3. Причинами ІХС є атеросклероз коронарних артерій та порушення їх тонусу.

4. До розвитку ІХС призводять гіперліпідемія, артеріальна гіпертензія, паління, гіподинамія, надлишкова маса тіла та висококалорійне харчування, цукровий діабет і генетична схильність.

5. Основним патогенним фактором є атеросклеротичне ураження коронарних артерій.

6. Найбільш частим проявом хронічної ІХС є стенокардія, що характеризується нападами загрудинного болю.

7. Головний принцип лікування хворих із стабільною стенокардією - попередження ішемії міокарда та контроль її клінічних проявів.

8. Для попередження тромбоутворення в ділянці атеросклеротичної бляшки у пацієнтів із нестабільною стенокардією застосовують гепарин.

Exercise 16. Open the brackets using appropriate Participle:

1. A stroke, previously (to know) medically as a cerebrovascular accident (CVA), is a rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain.

2. This can be due to ischemia (lack of blood flow) (to cause) by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).

3. As a result, the area of the brain (to affect) with the stroke, is unable to function, (to lead) to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

4. Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation. The patient (to have) a stroke previously is twice as probable to have the stroke again.

5. A silent stroke is a stroke that (not to possess) any symptoms, and the patients are typically unaware they have suffered a stroke.

6. Those (to suffer) from a major stroke before, are at risk of having silent strokes.

7. An ischemic stroke is occasionally treated at hospital with drugs (to exhibit) thrombolytic action (also known as a " clot buster"), and some hemorrhagic strokes benefit from neurosurgery.

8. The treatment (to involve) health professions such as speech and language therapy, physical therapy and occupational therapy is performed in a stroke unit.

Exercise 17. Choose the correct answer. Translate the sentences:

1. The surgeon …………….. the cardiotomy, was observed by a group of students.

1. performed

2. performing

3. having performed

4. being performed

2. This cardiologist …………… the operations without complications is known worldwide.

1. performing

2. performed

3. perform

4. having performed

3. ……………. loudly about the food to her mother, the child refused eating.

1. complained

2. complaining

3. having complained

4. complains

4. A neurosurgeon was seen …………….. the tissues with a scalpel.

1. dissect

2. have dissect

3. dissecting

4. dissected

5. A doctor spoke with the patient ……………. about exhaustion, and the correct diagnosis was established.

1. complaining

2. having complained

3. complain

4. complains

6. Suddenly the students saw a patient ……………. his head and body in an epileptic seizure.

1. move

2. moving

3. moved

4. moves

7. After …………. all the results of the examination, the technician started analyses.

1. being recorded

2. recorded

3. record

4. having recorded

8. The dentist ………… a very unique operation works at this department.

1. performed

2. performing

3. having performed

4. being performed

9. …………… operated twice with complications, she didn't trust medicine anymore and tried to avoid surgeries.

1. operated

2. operating

3. having operated

4. having been operated

10. A boy ………… by a pediatrician feels better than yesterday.

1. observed

2. observing

3. observes

4. having observed