Treatment of the Ischemic Heart Disease

Cardiologists of the private clinic of Herzliya Medical Center specialize in advanced methods for the diagnosis and treatment of ischemic heart disease. The use of innovative technologies and modern protocols of conservative, minimally invasive and surgical treatment, for the analysis of coronary circulation has significantly improved the prognosis of the disease, preventing the development of dangerous complications.

Ischemic heart disease: why are coronary vessels affected?

Coronary heart disease (CHD, ischemia) includes a number of diseases caused by a mismatch between the energy needs of the myocardium and the ability of the coronary vessels to deliver oxygen, as well as the required amount of nutrients. CHD can develop in the following conditions:

• Progressive narrowing of the coronary vessels caused by intravascular changes. Atherosclerosis is the most common cause of myocardial ischemia.
• Coronary artery spasm caused by stress or hormonal disorders
• Conditions that cause an increase in the energy requirements of the heart muscle, such as myocardial hypertrophy, metabolic dysfunctions and rhythm disturbances
• Anemia that facilitates the development of ischemia due to impaired blood transport function (low hemoglobin level reduces the amount of oxygen delivered to the heart muscle)
• Diseases that cause Hypoxia (oxygen deficiency)

Risk factors that might cause ischemia include

• Genetic predisposition in patients with congenital disorders of metabolism
• Age. The probability of ischemia increases in proportion to age
• Gender. Coronary circulation disorders are more common in men, most likely due to hormonal influence
• Overweight and obesity
• Low physical activity
• Nicotine and alcohol addiction
• Diabetes
• High blood pressure and conditions accompanied by a secondary increase in blood pressure

Coronary heart disease can be classified by three main clinical forms

Sudden cardiac death

Sudden cardiac death. The disease, also known as primary cardiac arrest. It is associated with severe disorders in the conduction system. Acute ischemic process in the area that is responsible for the occurrence or conduction of electrical impulses that cause myocardial contraction can lead to sudden cardiac death. Timely resuscitation measures help to restore cardiac activity, while failure to provide the necessary medical care leads to a tragic outcome.

Angina pectoris

Angina pectoris. This most common classification of ischemic heart disease is associated with transient acute impairment attacks of the coronary circulation. Partial obstruction of the heart vessels leads to oxygen insufficiency in the myocardium. Clinical manifestation of angina pectoris is a severe pain behind the sternum, often radiating to the left arm, lower jaw, back or epigastric region. The attack is accompanied by anxiety, difficulty in breathing and often profuse sweating. The duration of an angina attack is from several minutes to half an hour. The heart attack lasting more than 30 minutes indicates irreversible changes to the heart muscle (myocardial infarction). There are two types of angina – stable angina (the occurrence of the attack is influenced by the physical activity) and unstable angina (the attack occurs at rest).

Myocardial infarction

The third form of ischemic heart disease is myocardial infarction, which develops as a result of a prolonged ischemic process, leading to necrosis of the heart muscle. Myocardial infarction resembles an attack of stenocardia; however, in contrast to a temporary violation of blood circulation, the pain does not stop with vasodilators and lasts more than 30 minutes. Irreversible changes in the myocardium can cause severe arrhythmias, which are the most common cause of death in the acute stage of myocardial infarction.

Symptoms and diagnosis of the ischemic heart disease

Diagnosis of ischemia is based on anamnesis, the presence of risk factors, characteristic symptoms during an attack and the results of additional medical studies, among which of particular importance are:

• Electrocardiography. This method is based on the recording of electrical potentials of the cardiac conduction system. One of the symptoms of coronary heart disease is the changes detected in the electrocardiogram. This medical study also allows diagnosing cardiac arrhythmias, which often complicates the course of CHD
• Echocardiography (ultrasound examination of the heart) makes it possible to evaluate the contractility of the myocardium and to identify the areas of dyskinesia (impaired motor function, which is a typical cause of irreversible changes in the heart muscle)
• Functional studies with physical or drug load (ergometric tests). These methods are required to diagnose coronary circulation in patients, suffering from stable angina pectoris
• Laboratory diagnosis of coronary artery disease allows determining biochemical signs of muscle fiber destruction as a result of necrosis, which is one of the main criteria for the differential diagnosis between angina and myocardial infarction
• Invasive diagnosis of coronary circulation – coronary angiography. The method is also known as coronary artery catheterization. The study involves the introduction of a flexible catheter through peripheral blood vessels. The catheter reaches the main arteries of the heart. The introduction of a contrast substance helps to diagnose a narrowing of the vessel lumen. This technique also allows to carry out a minimally invasive procedure of balloon expansion and to strengthen the narrowed areas of large coronary vessels.
• Virtual coronary angiography. An innovative method of non-invasive diagnosis of coronary vessels with the use of a special computed tomography protocol. This method allows determining the location and severity of the narrowing of the coronary vessels accurately, without resorting to catheterization

Modern methods for the treatment of ischemia

In the cardiology department of the Herzliya Medical Center, a complex approach is applied to the treatment of coronary heart disease. It consists of:

• Drug therapy. Modern drugs are used to alleviate the symptoms of coronary heart disease in mild forms of stable angina, as well as in complex therapy for all forms of coronary artery disease. Cardiologists of the clinic use drugs that expand coronary vessels, reduce myocardial oxygen demand, normalize lipid metabolism, and also prevent thrombosis in vessels undergoing atherosclerotic changes. In the presence of appropriate indications, highly effective antiarrhythmic drugs are used.
• Minimally invasive heart surgery. In the clinic, modern methods of endovascular coronary angioplasty are practiced, including balloon dilation and coronary stenting. These methods allow restoring the normal lumen of the constricted arteries without resorting to open-heart surgery. The procedure is performed during catheterization under X-ray control.
• Coronary artery bypass surgery. This procedure is carried out when it is impossible to achieve the desired result using minimally invasive methods for patients suffering from severe stenosis of the coronary arteries. During the coronary artery bypass surgery, a complete restoration of blood circulation to myocardial areas, suffering from ischemia, is achieved with the use of arterial or venous autografts.

The vast experience of the leading Israeli cardiologists, modern medical equipment and an individual approach to each patient guarantees the effectiveness of ischemia treatment at the Herzliya Medical Center. The multidisciplinary team of the hospital pays great attention to strict compliance with quality and safety standards, as well as to maximize patient comfort during hospitalization and outpatient treatment.