Heart attack and ischaemic heart disease

What is ischaemic heart disease?

Ischaemic heart disease, also called coronary artery disease, happens when the blood vessels supplying the heart become narrow or blocked. This comes from a gradual buildup of fatty deposits, cholesterol, and inflammation over time, which restricts blood flow to the heart muscle.

It ranges in severity from mild to life-threatening:

• Stable angina: chest tightness during exercise or exertion that goes away with rest.

• Unstable angina: chest pain that happens at rest or with light movement. This is a medical emergency.

• Heart attack (NSTEMI / STEMI): partial or total blockage of a blood vessel that damages the heart muscle, requiring immediate emergency care.

• Silent ischaemia: reduced blood flow to the heart without any painful symptoms, most common in older adults or people with diabetes.

Important: Sudden chest pain, pressure, or tightness at rest, particularly with radiation to the arm, jaw, or back, sweating, breathlessness, or nausea may indicate an acute myocardial infarction. Call emergency services immediately.

Symptoms of ischaemic heart disease

Symptoms can range from entirely absent in early disease to life-threatening in an acute coronary syndrome. Common presentations include:

Stable ischaemic heart disease:

• Chest tightness, pressure, or heaviness on exertion, usually in the centre or left side of the chest

• Radiation of discomfort to the left arm, jaw, neck, or back

• Breathlessness on exertion disproportionate to activity level

• Unusual fatigue with physical activity

• Symptoms that show up consistently at a similar level of exertion and ease within minutes of rest

Atypical presentations (more common in women, diabetics, and older adults):

• Breathlessness without chest pain as the primary symptom

• Fatigue, nausea, or epigastric discomfort

• Jaw or arm discomfort without chest symptoms

• Silent myocardial ischaemia with no symptoms at all

Acute coronary syndrome:

• Sudden severe chest pain at rest

• Profuse sweating, nausea, and vomiting

• Breathlessness and sense of impending doom

• In some cases: syncope (loss of consciousness)

What causes ischaemic heart disease?

Ischaemic heart disease comes from atherosclerosis, a systemic inflammatory and metabolic process that affects the arterial walls. Contributing causes include:

• Dyslipidaemia elevated LDL cholesterol, low HDL, and elevated ApoB are the primary lipid drivers of plaque formation. Lipoprotein(a) is a seperate genetically determined additional risk factor.

• Hypertension sustained elevated blood pressure damages the vessel lining and speeds up atherosclerosis, raising both plaque formation and the risk of plaque rupture.

• Diabetes and insulin resistance high blood sugar drives advanced glycation, oxidative stress, and vessel lining dysfunction, all of which significantly speed up coronary atherosclerosis.

• Smoking causes direct injury to the vessel lining, promoting clotting, and accelerates atherosclerosis throughout the vascular system.

• Obesity and metabolic syndrome promote dyslipidaemia, hypertension, insulin resistance, and systemic inflammation simultaneously.

• Chronic inflammation elevated CRP reflects systemic vascular inflammation, and predicts cardiovascular events independently of traditional risk factors.

• Genetic factors familial hypercholesterolaemia, PCSK9 variants, and other genetic determinants of lipid metabolism can significantly modify individual risk.

• Age and sex coronary atherosclerosis accelerates with age. Men tend to develop IHD around 10 years earlier than women on average, though post-menopausal women's risk quickly catches up.

• Female-specific risk factors pregnancy complications such as preeclampsia and gestational diabetes, early menopause, and autoimmune conditions like lupus and rheumatoid arthritis are established risk factors that are often under-recognised and left out of standard risk calculators.

• Sedentary lifestyle physical inactivity is an independent cardiovascular risk factor, and the less active someone is, the higher their risk tends to be.

How is ischaemic heart disease detected?

Ischaemic heart disease is detected through a combination of cardiovascular blood testing, cardiac imaging, and risk stratification tools.

Cardiac MRI Elfcare's full body MRI covers the thorax as standard, with the heart directly imaged. It can identify left ventricular hypertrophy from hypertensive heart disease, wall motion abnormalities suggesting a previous heart attack, myocardial scarring from previous ischaemic events, pericardial disease, and structural cardiac changes associated with long-standing ischaemic disease. While coronary artery anatomy itself requires dedicated coronary CT angiography or invasive coronary angiography for direct assessment, Elfcare's cardiac MRI provides important structural information about the consequences of ischaemic heart disease on the myocardium and cardiac chambers.

It's worth noting that a normal structural and coronary scan doesn't fully rule out disease, especially in women, who more often have microvascular or non-obstructive coronary disease that structural and angiographic imaging aren't designed to capture, even when real symptoms and ischaemia are present.

Blood tests Elfcare's panel includes a comprehensive cardiovascular risk profile covering the primary modifiable drivers of ischaemic heart disease:

• Total cholesterol, LDL, HDL, and triglycerides the foundation of cardiovascular risk assessment, identifying dyslipidaemia as the primary atherosclerotic driver

• ApoB a more precise measure of atherogenic particle burden than LDL alone, particularly useful in metabolic syndrome where LDL may underestimate risk

• Lipoprotein(a) a genetically determined independent risk factor unresponsive to standard lifestyle and statin treatment, identified only through dedicated testing

• HbA1c and fasting glucose diabetes and insulin resistance are major accelerators of coronary atherosclerosis

• Fasting insulin and HOMA-IR identify insulin resistance before diabetes develops, the earliest metabolic warning sign

• CRP elevated vascular inflammation independently predicts coronary events beyond traditional risk factors

• NT-proBNP elevated when the heart is under pressure or stress, detecting subclinical myocardial dysfunction before symptoms appear

• TSH and Free T4 thyroid dysfunction directly affects cardiovascular risk and cardiac function

• Creatinine and eGFR kidney function is closely linked to cardiovascular risk through shared vascular disease mechanisms

• Haemoglobin anaemia increases heart’s oxygen demand and can worsen ischaemia where coronary disease already exists

• Homocysteine elevated levels are associated with vessel lining damage and faster atherosclerosis

AMRA body composition analysis Elfcare's AMRA analysis measures visceral fat and muscle mass, the metabolic factors most directly tied to insulin resistance, dyslipidaemia, and cardiovascular risk.

Why early detection matters

Atherosclerosis begins in a person's 20s and 30s and progresses silently for decades before causing anything noticeable. For a significant number of people, the first sign of ischaemic heart disease is a heart attack or sudden cardiac death, with no warning symptoms and no prior diagnosis. Each major modifiable risk factor treated early, LDL, blood pressure, blood sugar, smoking, weight, reduces coronary event risk by 20 to 50% on its own, and considerably more in combination. Identifying Lp(a) elevation, familial hypercholesterolaemia, or insulin resistance decades before they have caused disease provides the longest window for intervention with the greatest lifetime benefit.

How Elfcare can help

Elfcare's blood panel provides one of the most comprehensive cardiovascular risk assessments available in a preventive health check, covering LDL, ApoB, Lp(a), HbA1c, fasting insulin, HOMA-IR, CRP, NT-proBNP, homocysteine, and thyroid function. Together these identify every major modifiable driver of ischaemic heart disease and detect early subclinical cardiac stress before symptoms develop.

Our cardiac MRI identifies structural consequences of ischaemic heart disease including previous silent myocardial infarction, ventricular hypertrophy, and wall motion abnormalities. Our AMRA analysis quantifies the metabolic risk factors most closely linked to coronary atherosclerosis.

If our blood tests or MRI identify significant cardiovascular risk or findings consistent with ischaemic heart disease, we take care of further diagnostics or refer you to the appropriate specialist.