Ischaemic heart disease (IHD) results from reduced coronary blood flow to the myocardium, when there is an imbalance between the supply of oxygen and myocardial demand. IHD includes angina pectoris and myocardial infarction.

Causes of IHD

Coronary blood flow to the myocardium may be reduced by obstruction due to the following:
• Atherosclerosis—most common.
• Thrombosis.
• Spasm.
• Embolus.
• Coronary ostial stenosis.
• Coronary arteritis (e.g. in SLE).

Common Presentations of IHD

Angina pectoris.
• Acute myocardial infarction.
• Heart failure.
• Sudden death.

Risk Factors for Coronary Artery Disease

The following factors are responsible for atherosclerosis:


• Age—Common in the elderly.
• Sex—Common in males. After menopause in females, the incidence is same.
• Family history—More common, if there is a family history of IHD.
• Genetic factors—A number of genetic factors have been linked with coronary artery disease.


• Smoking—IHD is more in smokers.
• Alcohol—Moderate alcohol consumption is associated with a reduced risk but high-intake increases the risk.
• Diet—High fats are associated with IHD. Diet low in fresh fruits, vegetables and polyunsaturated fatty acids are associated with increased risk.
• Obesity—Overweight have an increased risk.
• Exercise—More in sedentary workers.
• Hypertension.
• Diabetes mellitus.
• Hyperlipidaemia—High-serum cholesterol, triglyceride and low high-density lipoproteins (HDL), is associated with coronary atheroma.
• Psychosocial factors—stress, lack of social support, depression, anxiety.