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Decision Aid for Stable Ischemic Heart Disease
Stable ischemic heart disease (SIHD)
is often caused by coronary artery disease (CAD). CAD is narrowing or blockage of your heart arteries caused by a buildup of plaque. Plaque is made up of cholesterol and other substances. The narrowing or blockages of your heart arteries prevents blood and oxygen from reaching your heart muscle. This is called ischemia. Over time, ischemia can lead to an abnormal heartbeat, heart attack, and heart failure. Early diagnosis and treatment can help prevent these problems.
Signs and symptoms of SIHD:
You may or may not have symptoms of SIHD. Signs and symptoms may get worse with activity, such as climbing stairs. Talk to your healthcare provider if you have any of the following symptoms of SIHD:
- Chest pain, abdominal pain, or pain in your shoulder, neck, or upper arm
- Shortness of breath
- A fast heartbeat
- Sweating or clammy skin
- Feeling tired or having low energy levels
- Dizziness or fainting
Screening for SIHD:
Screening for SIHD means you have tests done to check for ischemia. Other heart problems may also be found during screening. The results can help you and your provider decide if you need treatment.
How to tell if you are a good candidate for SIHD screening:
You may be screened for SIHD if you have any symptoms of SIHD. You may also be screened if you have risk factors for SIHD. Examples include the following:
- A history of a heart attack
- A family history of heart disease
- High cholesterol or blood pressure
- Chronic kidney disease
- Being overweight
- A lack of exercise
- Smoking or heavy alcohol use
How screening is done:
- Your healthcare provider will examine you. He or she will check your blood pressure and weight. You may need an electrocardiogram (EKG). An EKG test records your heart rhythm and how fast your heart beats. It may show problems with how your heart beats, or heart damage. Tell the provider if you smoke, drink alcohol, or use illegal drugs. Also tell him or her about any symptoms you have, such as chest pain or shortness of breath. The provider will ask about other health conditions, medicines you take, and your activity level.
- Your healthcare provider may recommend 1 or more screening tests based on your history and symptoms. The provider's choice of screening tests may depend on your age and how much you can exercise. Examples of screening tests include a CT scan, stress test, or a heart catheterization.
Benefits and risks of screening for SIHD:
Talk with your healthcare provider about the risks and benefits of screening:
- Benefits include finding ischemia before it causes life-threatening problems. It may be possible to prevent more damage to your heart. Results of screening can help you and your healthcare provider create a treatment plan that is right for you.
- Risks of each screening test are different. Some tests, such as an EKG, blood test, or CT scan, have few risks. You do not need to prepare for those tests. The following tests have more risks, and you may need to prepare for each test:
- A stress test includes risks such as chest pain, abnormal heartbeat, dizziness, or a heart attack. Medicine given to stress your heart may cause wheezing or shortness of breath. The contrast liquid may cause kidney damage or an allergic reaction.
- A heart catheterization includes risks such as heavy bleeding or an infection. The catheter used during the procedure may damage your heart or blood vessels. You may get a blood clot in your arm or leg. You could have a heart attack or stroke during or after the procedure. Your heart could have irregular beats. The contrast liquid may cause kidney damage or an allergic reaction.
Questions to ask your healthcare provider to help you make decisions about screening:
Ask your healthcare provider the following questions to help you make a decision about screening:
- How high is my risk for a heart attack or other heart problems?
- Do the benefits of screening outweigh the risks for me?
- Will I be able to help create my treatment plan if screening shows I have SIHD or other problems?
- Will my insurance cover screening?
- Where is the screening done?
- Do I need to do anything to get ready to have screening?
- What happens during each screening test?
- When and how do I get the results of my screening?
What happens after you have screening for SIHD:
You will meet with your healthcare provider to go over the results of your screening. You, your family or caregiver, and your healthcare provider can talk about your treatment options. Together you can decide which treatment is right for you. Treatment choices may depend on your age and other health conditions. It may also depend on how severe your ischemia is and how well your heart is currently working. Treatment may include medicines, procedures, cardiac rehab, or changes to your lifestyle.
How SIHD is treated, and what are the benefits of treatment:
You may need more than 1 treatment to manage SIHD.
- Lifestyle changes include diet and exercise. These changes can help you lose weight, and decrease your blood pressure and cholesterol. Lifestyle changes may also help decrease your symptoms and risk for a heart attack.
- Medicines can help decrease stress on your heart and prevent a heart attack. Medicines may also decrease symptoms, such as chest pain and shortness of breath. Medicines may be combined with other treatments. You may need any of the following medicines:
- Blood thinners or antiplatelet medicines to prevent blood clots
- Cholesterol medicine to lower and control your cholesterol
- Blood pressure medicine to lower and control your blood pressure
- Nitrates to relieve chest pain
- Percutaneous coronary intervention (PCI) , also known as angioplasty, may be done to open an artery blocked by plaque. This can help increase blood flow and oxygen to your heart. It can also help decrease your risk for a heart attack. A tube with a balloon on the end is threaded into the blocked artery. Once the tube is in the artery, the balloon is inflated. As the balloon inflates, it presses the plaque against the artery wall to open the artery. A stent may be placed in your artery to keep it open.
- Coronary artery bypass surgery (CABG) is open heart surgery. Healthcare providers take arteries or veins from other areas in your body and use them to bypass or go around the blocked arteries of your heart. A CABG can help treat ischemia and decrease your risk for a heart attack.
Risks of SIHD treatment:
- Lifestyle changes will not reverse the damage to your heart. They will only prevent symptoms from getting worse.
- Medicines will not fix heart damage that you already have. Medicines may decrease symptoms, improve the heart's pumping action, and help prevent more damage. Medicines to treat SIHD have side effects. Examples include an increased risk of bleeding, abnormal heartbeat, or low blood pressure. Even with medicine, you may still have a heart attack or other heart problems. Ask your healthcare provider for a complete list of side effects for each medicine.
- PCI has the following risks:
- You may develop a hematoma (swelling caused by collection of blood) or bleed more than expected from your catheter site. The contrast liquid used during angioplasty may cause an allergic reaction or kidney problems. You may develop an infection. An artery in your heart may become completely closed or have a spasm. If this happens, your heart will not get enough blood. This may cause chest pain or a heart attack. You might need heart surgery right away to bypass (go around) the artery.
- You may get a blood clot. The clot may cause life-threatening problems, such as a heart attack or stroke. Your arteries may become blocked again, and you may need another angioplasty or heart surgery.
- Coronary artery bypass surgery (CABG) has the following risks:
- You may develop an infection. You may bleed more than expected and need a blood transfusion. You may have fast, irregular heartbeats. Your heart may not get enough oxygen and have trouble pumping blood through your body after surgery. Your signs and symptoms may come back. You may need another CABG.
- You may have fluid buildup around your heart. This fluid puts pressure on the heart and prevents it from working properly. You may also have fluid buildup around your lungs. This may make it hard for you to breathe after surgery. You may get a blood clot in your leg or arm. These problems can be life-threatening.
Questions to ask your healthcare provider to help you make decisions about treatment:
The following are questions you can ask your healthcare provider about each treatment:
- Do the benefits of treatment outweigh the risks for me?
- Will my insurance cover treatment?
- Where is the treatment done?
- Do I need to do anything to get ready for the treatment?
- How will I know if the treatment is working?
- If the treatment does not work, what other treatment choices do I have?
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