Do you sometimes feel like you can't climb stairs or walk long distances like you used to? Do you find it hard to breathe even when doing small tasks? Or do your feet swell up and you can't even put on your shoes? While many people think of these as normal fatigue, sometimes there may be a more serious reason behind this. Today we are going to talk about such a condition, namely 'Ischemic Cardiomyopathy', a disease in which the heart muscle weakens due to reduced blood flow to the heart.
Simply put, what is Ischemic Cardiomyopathy?
Imagine that our body is a big city. Then the heart is the main pumping station that supplies water to that city. In order for this pumping station (the heart) to continue working, it also needs a separate power source, that is, a blood supply. We call these blood vessels that supply blood to the heart the coronary arteries.
Now imagine, what happens if these coronary arteries start to get clogged? Just like water pipes get clogged with dirt and the flow of water decreases, things like cholesterol and fat get deposited inside these arteries and the blood flow becomes narrow. This is what we call Coronary Artery Disease .
When this blood flow is reduced, the heart muscle does not get the oxygen and nutrients it needs. Just as a tree gradually dies when it lacks water, the heart muscle also begins to weaken and become damaged. Over time, this weakened heart is unable to pump the amount of blood the body needs. The left ventricle, the main pumping chamber of the heart, becomes weak and enlarged. This is the complete condition we call `Ischemic Cardiomyopathy`.
Simply put, this disease is a condition in which the heart muscle weakens due to blockage of the blood vessels supplying the heart, reducing the heart's ability to pump . This is the leading cause of heart failure in the world.
What are the symptoms of this disease? How do we recognize it?
Most of the time, these symptoms don't appear all at once. They develop gradually. Some people may have this condition without any symptoms at all. However, there are a few common symptoms.
| Symptom | A simple explanation |
|---|---|
| Difficulty breathing (dyspnea) | Wheezing occurs especially when you are exercising (walking, climbing stairs). As the disease progresses, you may have difficulty breathing even when you are just standing or lying down. This is because the heart is weak and cannot pump blood to the lungs properly, causing fluid to accumulate in the lungs. |
| Swelling of the legs and feet (Edema) | Because the heart can't pump blood properly, fluid begins to accumulate in the lower parts of the body, especially the legs and ankles. If you feel a throbbing sensation when you press on those areas with your finger, this could be a symptom. |
| Unbearable fatigue and tiredness `(Fatigue)` | Because the body's organs do not receive the oxygen and nutrients they need, you may feel so tired that you cannot even perform normal daily tasks. |
| Chest pain or tightness (Angina) | This doesn't happen to everyone. But when the heart doesn't get enough blood, especially when you're tired, you can feel a tightness or a weight in your chest. |
| Abnormalities in the heartbeat (Arrhythmia) | Palpitations may be felt as if the heart is beating rapidly or skipping beats. This is because the heart's electrical system is also affected. |
| Dizziness and lightheadedness | When the brain doesn't get the right amount of blood, you may feel dizzy and sometimes faint. |
The most important thing is, if you have these symptoms, to see your doctor as soon as possible, without assuming that "this is normal."
Why does this happen? What are the risk factors?
As we discussed earlier, the main cause is coronary artery disease . This means that the arteries that carry blood to the heart are blocked. In addition, a previous heart attack is also a major cause. A heart attack is when the blood supply to a part of the heart is completely cut off, causing the heart muscle to die.
So, the risk factors that contribute to the development of coronary artery disease also contribute to the development of `Ischemic Cardiomyopathy`.
Risk factors:
- High Blood Pressure: When blood pressure increases, blood vessels become damaged and the chance of cholesterol being deposited inside them increases.
- Diabetes: Diabetes also causes damage to the walls of blood vessels.
- High Cholesterol: When the amount of bad cholesterol (LDL) in the blood increases, it deposits in the blood vessels and blocks the blood flow.
- Tobacco use (smoking): Smoking is the biggest cause of damage to blood vessels.
- Family history: If anyone in your family (mother, father, siblings) had heart disease at a young age, you are also at higher risk.
- Overweight and Obesity: When you gain weight, your heart works harder. It also increases your risk of developing diseases like diabetes, high blood pressure, and cholesterol.
- Lack of exercise: A sedentary lifestyle is also a big reason for this.
How does the doctor diagnose this disease exactly?
When you go to the doctor, he will first listen carefully to your symptoms and your family medical history. Then he will examine your body. In addition, he will order several tests to confirm the diagnosis.
- Blood Tests: Check things like cholesterol levels, sugar levels, and kidney function.
- Electrocardiogram (ECG): This test records the electrical activity of the heart and can help determine if there has been a previous heart attack or if there are any abnormalities in the heart rhythm.
- Chest X-ray: Check for an enlarged heart and fluid accumulation in the lungs.
- Echocardiogram (Echo): This is like a scan of the heart. It uses sound waves to clearly see the chambers of the heart, valves, and the way the heart muscle is pumping (Ejection Fraction). This is a very important test to diagnose this disease.
- Exercise Stress Test: An ECG is taken while you walk on a treadmill to see if your heart is getting enough blood when you exercise.
- Cardiac Catheterization / Angiogram: This is the best way to see exactly if your heart's blood vessels are blocked. A thin tube is inserted through a vein in your arm or leg, passed into the coronary arteries of your heart, a special dye is injected, and an X-ray is taken. This shows exactly how blocked the blood vessels are.
What are the treatments for this?
There are three main goals of treatment:
1. Treat the cause (i.e. coronary artery disease).
2. Improving heart function.
3. Reduce symptoms and improve quality of life.
For this, several treatment methods are used together.
1. Medicines (types of medicines)
The medications given for this purpose reduce the burden on the heart, improve heart function, and prevent additional complications.
| Drug category | Functionality (simple) |
|---|---|
| Beta-blockers | It controls the heartbeat a little and reduces the burden on the heart. |
| ACE Inhibitors / ARBs | It widens blood vessels, reduces pressure, and makes it easier for the heart to pump blood. |
| Diuretics | They help to eliminate excess water accumulated in the body through urine. These are very helpful for swelling in the legs and feet. |
| Anticoagulants | They prevent blood clotting. These are given to these people because they are at risk of blood clots and strokes. |
| Statins | It reduces cholesterol levels and prevents further blockage of blood vessels. |
Important: It is essential to take the medication prescribed by your doctor exactly as prescribed, at the correct time, and in the correct dosage. Never stop taking your medication or change the dosage on your own.
2. Lifestyle changes
Doing these things is just as important as taking medicine.
- Salt control: Reduce the amount of salt you eat per day. Salt is not just the salt you add to your food. There is also hidden salt in things like prepared foods, sauces, ketchup, biscuits, and bread.
- Exercise: As per your doctor's advice, engage in exercise at the level you are able. Even just walking for 30 minutes a day is good.
- Avoid smoking: If you smoke, stop it completely.
- Healthy diet: Eat more vegetables, fruits, legumes, and whole grains. Reduce foods high in oil, sugar, and flour.
- Weight control: Maintain a healthy weight for your height.
3. Surgery and other treatments
If the condition cannot be controlled with medication and lifestyle changes alone, the doctor may refer you to other treatment options.
- Angioplasty and Stents: During an angiogram, the blocked blood vessel is inflated with a balloon-like device, and a small mesh-like device called a stent is placed inside to prevent it from becoming blocked again.
- Coronary Artery Bypass Surgery: If a blood vessel is blocked in multiple places, a new route is created by using a blood vessel taken from another part of the body (leg or chest) to bypass the blocked area. This is called a 'bypass' surgery.
- Implantable Devices: If the heart rate is very irregular or the heart's pumping ability is very weak, a small electronic device such as an `ICD (Implantable Cardioverter Defibrillator)` or `CRT (Cardiac Resynchronization Therapy)` can be implanted under the skin of the chest. These control the heart's rhythm.
- Heart Transplant: A healthy heart transplant is considered as a last resort for patients in the most severe stages of the disease who have not responded to any other treatment.
Can the disease be prevented?
Yes, absolutely. The best way to prevent `Ischemic Cardiomyopathy` is to prevent the coronary artery disease that causes it from developing. That means controlling the risk factors we discussed earlier.
- Eat a healthy diet.
- Exercise regularly.
- Avoid smoking completely.
- Control your body weight.
- If you have diseases like diabetes, high blood pressure, or cholesterol, control them well according to your doctor's instructions.
- Control stress.
When should you go to a hospital (ETU) immediately?
If you have this disease or are at risk of heart disease, go to the Emergency Department (ETU) immediately if you experience the following symptoms:
- If you have severe chest pain or a feeling of tightness in your chest.
- If you feel extreme difficulty breathing.
- If you experience drowsiness or dizziness.
Since these can be symptoms of a heart attack, seeking treatment without wasting time can even save lives.
Take-Home Message
- Ischemic Cardiomyopathy is a condition in which the heart muscle weakens due to reduced blood flow to the heart, reducing its pumping ability.
- The main symptoms of this include fatigue, swelling in the legs, and extreme fatigue. Don't ignore these as normal.
- The main cause is coronary artery disease. Diabetes, blood pressure, cholesterol, and smoking are the main risk factors.
- This disease can be well controlled. There are treatments available, including medications, lifestyle changes, and, if necessary, surgery.
- It is very important to follow the doctor's instructions exactly and to go to the clinics on the scheduled dates.
- This disease can be prevented by following a healthy lifestyle.
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