Heart is a pump that continuously pumps blood into all the organs of the body. The pump itself is made of muscles which also require continuous flow of blood for proper functioning. Heart disease due to lack of effective circulation of blood to the heart is called ischaemic heart disease (IHD). IHD is one of the commonest diseases as well as causes of death in advancing years.

There are several manifestations of IHD: from silent disease to sudden death. However, the most frequent manifestations of IHD are angina (chest pain associated with physical activity) and acute myocardial infarction (heart attack). Heart attack results from sudden stoppage of blood flow in the arteries that supply blood to the heart (coronary artery). As a result parts of the heart muscles die out or are lost permanently. Angina is a milder and reversible form of heart attack. Ischaemic heart disease is the result of a process of narrowing of blood vessels (atherosclerosis), a disease in which cholesterol (fat in blood) gets deposited inside the walls. This process of atherosclerosis affects the blood vessels of the brain leading to stroke and the limb vessels leading to gangrene.

There are several risk factors for developing IHD. These are divided into unmodifiable factors (which cannot be altered) such as gender (male sex), age (increasing age), race (blacks, south Asians) and family history and modifiable factors such as smoking, obesity, high cholesterol levels and high blood pressure.


Angina is a symptom which usually lasts for just a few minutes. You may feel tightness or heaviness in the chest, breathless, pressure, squeezing or burning in the chest, discomfort that may spread to the arms, neck jaw or back and numbness or tingling in shoulders, arms or wrists.

Angina usually appears when you climb stairs, carry a heavy load, feel angry or upset, work in very hot or cold weather, have sex, have emotional stress, do exercise or a combination of any of these. Typically it disappears when you stop these activities or put a tablet of nitroglycerin (sorbitrate) under your tongue. The diagnosis of angina is always clinical. However, you require the following tests for confirmation:

Blood tests (cholesterol) Electrocardiogram (ECG) Exercise ECG (Treadmill test)
Cardiac catheterization which shows where the artery is blocked.
Stress thallium test to demonstrate reversible ischaemia

Your doctor may give you nitroglycerin tablets, a medicine to relieve the discomfort which you put under your tongue. Some people get a headache after taking a nitroglycerine

When seeking advice be sure to ask your doctor about what to do if you get angina and how to use your nitroglycerin the right way. If you get angina you need to take a second look at your lifestyle and have to take a few corrective steps. There is no point in giving in to ischaemic heart disease. Rather you can fight it out. It is necessary that you:

Stop smoking eat healthy meals Control high blood pressure and blood cholesterol level
Call your doctor if your angina changes; for example, if you get angina while resting or if it gets worse.
Learn to relax and manage stress avoid strenuous activities.


The most frequent symptom of heart attack is chest pain. It is usually similar to angina but much severe in intensity. Some people get heart attack even without getting angina. They usually experience it as the worst kind of chest pain that they have ever felt. There are several atypical forms of manifestations of heart attack which include fainting and severe shortness of breath. In older people and diabetics, chest pain may be absent. Heart attack is usually diagnosed by doing an ECG.

Now-a-days heart attack is no longer incurable. Drugs have been developed which can open up the narrowed blood vessels of the heart. Furthermore, immediately after the heart attack you can be subjected to definite surgical and non-surgical procedures to correct the defects in your heart vessels. So, the good news is that the worst is over and soon you can do most of the things you used to do!

It is time to make healthy changes in your lifestyle. Heart disease can get worse unless you take steps to get your heart in good shape. After a heart attack, it is not unusual to worry a lot. Getting better and feeling good about yourself will take time. It helps to do as your doctor says and to learn about keeping your heart healthy. You may have many active years still left to enjoy. Most patients say they have bad feelings after a heart attack. These feelings are normal and easy to understand.

You may have fear of dying, of chest pain; and fear that you can’t have sex and that you can’t work.
You may feel angry that it happened to you.
You may feel depressed thinking that “life is over”, you might not be the same again, and others might think you are weak.
Not only you but people close to you also feel your heart attack.


Most people go back to work within 1 to 3 months. Your doctor may ask you to take tests to find out if you can do the kind of work you did before. Some people change jobs to make it easier on their heart.