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What is Ischaemic Heart Disease?
Ischaemic heart disease, also known as coronary heart disease (CHD), is when there is an inadequate circulation of blood and oxygen to the heart. This is usually caused by a narrowing of the heart (coronary) arteries often due to a build up of plaque (atherosclerosis), or due to a blood clot or a constriction of the blood vessel.
When the blood flow to the heart is completely blocked, the heart muscle cells die, resulting in life-threatening heart attack or myocardial infarction (MI).
What are the signs and symptoms of CHD?
Often times people with less than 50% (early) narrowing would not get symptoms.
However as CHD progresses, the deprivation of oxygen to the heart will result in discomfort in the chest, jaw, shoulder, back or arms, termed angina pectoris.
Angina is classified using the Canadian Cardiovascular Society (CCS) scheme based on level of activity that causes symptoms:
Class 1 – angina occurs with strenuous or rapid or prolonged exertion at work or recreation, but not with ordinary physical activity. Examples included climbing hills, cycling, jogging 10-minute mile, fast dancing or playing tennis or squash.
Class 2 – angina that slightly limits ordinary activity. Symptoms precipitated by walking or climbing more than one flight of stairs at a rapidly, walking up hill, walking more than two blocks, emotional stress, or during the first few hours of awakening.
Class 3 – symptoms that markedly limits ordinary physical activity. This describes angina with walking one or two blocks on level ground, climbing one flight of stairs, household chores, gardening or walking the dog.
Class 4 – inability to carry on any physical activity without discomfort, with symptoms even at rest.
How likely am I to develop CHD?
An estimated 643,000 Australian adults (3.6%) were diagnosed with CHD. Of these, 281,000 experience angina and 428,000 had a previous heart attack.
CHD occurs more commonly in older age groups, affecting 1,7% of people aged 45- 54 and 17% of those over 75 years old. with men 1.7 times more likely to develop CHD than women. Indigenous and remote populations were 2 times and 1.6 times more likely to have CHD, respectively. A family history may increase your risk of experience heart disease.
What are the risk factors for CHD?
Unfortunately it is difficult to choose your family or where you were born.
Key risk factors that you should aim to control include:
-High blood pressure
How do I manage CHD?
Understanding and addressing the above associated factors will reduce your chances of developing and progressing CHD.
Managing your sleep and rest; emotional stresses; body and movement; work, home and social interactions; and eating habits will all help to reduce angina symptoms and allow you to continue an active lifestyle.
Pharmacological intervention and myocardial revascularisation when indicated may also reduce mortality and morbidity associated with CHD.
Can Physiotherapy help you manage CHD?
As CHD results in a poor exercise tolerance, this often results in reduced activity, which further perpetuates the progression of CHD.
Physiotherapists can help with monitoring the severity of heart disease through exercise stress tests. This usually involves testing your exercise tolerance with the use of treadmill or bike ergometry. As the difficulty ramps up, the efficiency of the vessels are measured through monitoring of perceived exertion and/or electrocardiogram. An abnormal test result at a low workload is the most reliable indicator of a higher likelihood of multivessel CHD.
Through consultation and assessment, physiotherapist may help identify associated diseases and risk factors; application non-pharmacological interventions to help with ailments limiting activity and assessing and progressing exercise tolerance to help with management of angina and ischemia.