Coronary heart disease

Coronary heart disease is a heart disease in which there is a lower blood supply to the myocardium (which is how the heart muscle is called) due to the obstruction of the coronary arteries, which are the ones that carry blood to the myocardium. This phenomenon is called ischemia.

The consequences of this lack of perfusion can appear in the form of chest pain, as occurs in angina pectoris or acute myocardial infarction. Ischemia can occur abruptly, as in heart attack, or chronically, triggered by increased cardiac pumping demands on the body, as occurs in exertional angina.

The first symptom of coronary heart disease is usually the so-called angina pectoris, which generally manifests as a crushing pain in the central part of the chest. This pain is caused by a partial lack of oxygen in the heart muscle. blood continues to flow to the heart muscle but in a smaller quantity than necessary: ​​this is the well-known myocardial ischemia. The main characteristic of angina pectoris is that it is generally reversible, there is no damage to the cells of the heart muscle and when the blood supply is sufficient again (due to an increase in the amount of blood that arrives or a decrease in needs), the pain disappears and the heart returns to its previous situation. If the ischemia is more prolonged, the death of the myocardial cells occurs, that is, an infarction occurs.

Cardiac ischemia can also have non-painful consequences such as the silent deterioration of the heart muscle, which can trigger heart failure.

The underlying cause of ischemic heart disease, in most cases, is the obstruction of the coronary arteries due to arteriosclerosis (calcified cholesterol deposits). Therefore, it is essential to prevent and treat risk factors associated with its formation and progression, such as, among others, smoking, high blood pressure, diabetes, hyperlipidemia and obesity.

Coronary heart disease is probably the most common cardiovascular disease in the elderly. It is the cause of many deaths in addition to producing disability and serious limitations in the normal activity of patients. Suffice it to say that two out of every three heart attacks occur in people over 65 years of age. This disease is more serious, has a worse prognosis and presents a greater number of complications in this population group, already fragile, with concurrent diseases that make management difficult, and polypharmacy, which increases the risk of side effects and interactions.

In older people, the symptoms of ischemic heart disease can appear atypically, lacking the classic forms of chest pain and instead appear respiratory distress, fatigue or mental symptoms such as confusion or agitation. There are also silent forms of cardiac involvement or it can directly be established as sudden death.

Ischemic heart disease crises are often precipitated by the concurrence or exacerbation of other diseases that the elderly present. On many occasions, this atypicality makes it difficult to recognize and causes delays in seeking medical assistance.

In the elderly, this disease has a worse prognosis and the need for individualized treatment according to the circumstances of each person (presence of other diseases, cognitive impairment, disability, benefits and risks of the procedures, etc.).

The treatment of coronary artery disease is based on different combinations of measures between drugs, invasive interventional procedures on the coronary arteries and even their surgical revascularization. This sometimes requires intensive procedures, with a greater number of complications in the elderly, although there are no benefits with them. Despite the multiple studies on the treatment of this pathology, there are not many carried out in elderly people, taking into account the particularities of this age group.

For all this, in ischemic heart disease almost more than in other pathologies, the biological age and not the chronological age must be taken into account when making decisions regarding therapeutic measures, individualizing them in each case.