Heart disease is a disease of the heart. “When the heart muscle no longer receives enough oxygen, we speak of ischemic heart disease,” explains Dr. Stéphane Manzo-Silberman, cardiologist at Lariboisière Hospital (APHP). “It can be acute – it’s myocardial infarction – or chronic – it’s stable angina pectoris.” It affects men more than women. “In 2017, 1,5 million people were treated for chronic coronary disease, including 75% over the age of 75,” recalls the High Authority for Health (HAS). Who insists: “This is the fourth most common long-term condition behind diabetes, cancer and psychiatric illness. “

Lack of oxygenation of the heart is most often caused by coronary atherosclerosis. This means that a plaque of atheroma – mostly made up of lipids – has built up in the lining of the arteries supplying the heart. This atheromatous plaque gradually clogs the coronary arteries. Until depriving the heart of oxygen. The risk of coronary heart disease increases with age. Sex plays a role: women are four times less likely to have a heart attack than men before menopause. After menopause? Both sexes are equal.

If nothing can be done about age or sex, there is another cause on which it is possible to act: hygiene of life. “The disease is largely due to cardiovascular risk factors: tobacco, high blood pressure, diabetes or a sedentary lifestyle,” confirms Dr Manzo-Silberman. Other contributing factors: stress and obesity. All of them are enemies of the arteries, gradually damaging them. In the shadows, until the arrival of complications, sometimes dramatic.

“Ischemic heart disease can be completely silent,” warns Dr. Manzo-Silberman. It thus remains asymptomatic for many years, even if in the shadows, the coronary arteries are suffering. Until its two main manifestations appear: angina pectoris or myocardial infarction.

Angina

Angina pectoris, or angina, has easily recognizable warning signs: chest pain triggered by exertion, quickly giving way on rest. The patient has the impression that his thorax is caught in a vice. Because the caliber of the coronary arteries is narrowed, the myocardium no longer receives enough oxygen for the effort involved. A doctor should be consulted promptly.

The infarction

Even more serious, myocardial infarction is a life-threatening emergency. Because in this case, a coronary artery becomes completely blocked, suddenly. Part of the myocardium, which no longer receives oxygen at all, is destroyed. The chest pain is severe. And unlike angina, it does not give way on rest. You have to call 15 immediately.

In the slightest doubt (shortness of breath, and of course pain in the chest), you should consult. The doctor begins with a questioning about symptoms, personal and family history. Additional examinations will be carried out, such as a stress test. “The electrocardiogram, on the other hand, can detect abnormalities suggesting heart pain,” describes Dr. Manzo-Silberman. ” THE’scan heart test allows you to see if all of the heart’s walls are contracting normally. The coronarographie allows, it, to diagnose a narrowing of the coronary arteries. “

Depending on the stage of ischemic heart disease, they aim to slow the progression of coronary heart disease, or to decrease the risk of myocardial infarction.

Treatment of angina pectoris

In the event of angina pectoris, medications will improve coronary circulation and / or reduce the work of the heart during physical activity: nitroglycerin, beta blockers, vasodilators, etc.

Treatment of myocardial infarction

In case of a myocardial infarction, thrombolytics may be given to try to dissolve the clots. A coronary angioplasty will make it possible to dilate the blocked arteries, to restore blood circulation, thanks to the installation of stents. “There may also be one or more coronary bypass surgery (s): the principle is to restore blood circulation downstream of the diseased artery area by means of an artery in the thorax. »There may be one or more bypass (s) performed during the same operation, depending on the number of damaged arteries.

To prevent the disease or avoid its aggravation, “we can act on many factors”, insists Dr. Manzo-Silberman. “And the most important… is to quit smoking! “. Tobacco is indeed catastrophic for our arteries. “We also need to screen for and treat high blood pressure, cholesterol and diabetes. Just as it is essential to have A balanced diet and regular physical activity. “In other words, follow the recommendations of the National Health Nutrition Program (mangerbouger.fr):” Increase fruits and vegetables, pulses (lentils, chickpeas, etc.), physical activity, at least 30 minutes per day. Go towards whole starches, fish, rapeseed, walnut and olive oil, dairy products. Reduce alcohol, sugary drinks, fatty, sweet, salty and ultra-processed foods, cold cuts. “What to put all the chances on his side to keep a heart in good shape as long as possible.