Laboratories in the CVRTI Metabolism Program investigate how alterations in bioenergetics contribute to various adult, congenital, and inherited forms of heart failure, using a combination of cutting-edge imaging, proteomic, metabolomic, and electrophysiological techniques.
The program consists of Dipayan Chaudhuri, MD, PhD (Director), Sarah Franklin, PhD, Guillaume Hoareau, DVM, PhD, and Joseph Palatinus, MD, PhD. The Chaudhuri Lab is exploring how altering mitochondrial ion transport may be a potential therapy for heart failure and metabolic diseases. The Franklin Lab’s research provides deep insights into how the control of transcription alters the progression of cardiac disease, partly via the control of metabolic pathways. The Hoareau Lab is focused on mitochondria-targeting therapies that prevent hemorrhagic shock and cardiac ischemia-reperfusion injury, particularly in military warfighters. The Palatinus Lab is focused on understanding how metabolic dysfunction triggers inflammation in arrhythmogenic cardiomyopathy, a genetic heart disease with no treatments available, where healthy cardiac tissue is slowly replaced by scar and fat. These groups with complementary skills share a common goal of developing potential therapies by identifying new pathways at the intersection of metabolism and heart failure.
Each of our hearts contains several billion individual muscle cells. Every second of our lives, these billions of cells need to contract and relax together for the heart to work effectively as a pump. Fortunately, our hearts have an electrical system that coordinates the individual cells, telling them when to contract and when to relax—the electrical system functions of bioelectricity.
The cells have individual ion channels that allow bioelectrical current in the form of charged ions to flow across the cell membrane, changing the voltage across each membrane. The cells also have channels between them, allowing the rapid spread of bioelectrical ions across the heart. A disturbance of the heart’s electrical system is caused by an arrhythmia.
Severe arrhythmias can cause the heart to stop, which is responsible for up to 300,000 deaths per year in the United States. At the CVRTI, we have a long history of pioneering in the field of electrophysiology research, including the genetic and acquired basis of heart electricity and heart arrhythmias. Investigators are now developing innovative methods to treat heart arrhythmias and prevent their occurrence, aiming to safeguard heart health through the understanding of channels, biology, and membrane proteins involved in cardiac bioelectricity.
Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies
Cardiac ischemia is a condition that is caused by a loss of proper blood flow to the heart, usually as a result of buildup in coronary arteries which are the arteries that feed the heart. Understanding how to treat this condition and manage a healthy lifestyle can go a long way in making ischemia a less life-threatening diagnosis. Of course, every patient is different, so the treatment options can be different as well.
It’s important to manage this condition because ischemia can lead to a higher risk of heart attack and heart disease, as well as a higher risk of death due to heart disease or heart failure. To manage it, of course, you need to start by having a better understanding of cardiac ischemia and all that it can do.
Symptoms and Diagnosis
Cardiac ischemia is usually characterized by pain in the chest or shortness of breath when you perform any strenuous activity. It may also include arm pain, tingling or numbness, and other symptoms, but it’s generally a feeling of discomfort all around. For those with more severe cases, the pain may also be more severe and that could indicate that getting treatment is even more serious.
There are several different diagnostic tools used to determine if someone has ischemic heart disease. An EKG test can be performed while a person is resting. The most diagnostic non-invasive option is to do a stress test. This can be done with physical exercise, or for those who can’t exercise, a chemical based test can be performed instead.
In a stress test, the heart is put under a lot of exertion to see what it can handle. At the same time, you’re hooked up to an ECG and carefully monitored. There are also instances where imaging and other diagnostic tools are used alongside stress tests to get an accurate diagnosis.
Managing Cardiac Ischemia
So, how do you manage cardiac ischemia? Well, that depends on several factors. For starters, it will be important to consider how severe your condition is. Those who have milder forms of the disease may not need to do as much. A few simple lifestyle changes could make a big impact. For others, it might become a full-time job to manage this condition. As mentioned, education goes a long way in helping.
What is the first line of treatment for ischemic heart disease? Usually, it’s a combination of medication(s) and exercise along with lifestyle changes. Especially when the condition is caught early enough, these efforts can make big impacts. The changes that you make to your lifestyle and the medications that you need will depend on your specific circumstances, of course, so be sure to talk to your doctor and figure out what’s best.
Exercise and Rehabilitation
Medications can help, as do exercise and rehab. Physical exercise is best, at a level that is comfortable for the individual. This can help strengthen the heart muscle, and improve overall health.
What exercise is good for ischemia? Honestly, there’s a lot that you can do. Aerobic exercise is best, such as walking, biking, light jogging, or even swimming. If you want to stick to the gym, try an elliptical for low-impact, high-power cardio. Also, make sure that you stretch before and after you exercise to keep your muscles loose and help your heart maintain a regular rhythm.
Talk to your doctor because not all exercises are good for all patients when it comes to heart disease. Some people may be limited to light walks and water aerobics, for example, because they are easy and low impact.
Lifestyle Changes
There are also several lifestyle changes that you may have to undertake as part of managing cardiac ischemia. In addition to adding exercise to your daily routine (30-60 minutes per day, five days per week), you should also:
Eat a diet low in saturated fats, trans fats, cholesterol, and salt.
Eat lots of whole grains, fruits, and vegetables.
Reduce stress and alleviate depression.
Stop smoking.
Limit alcohol intake (or just stop).
Take the prescribed medications for your heart condition and other diseases.
Create Your Management Plan
The best thing that you can do if you are diagnosed with cardiac ischemia is to work with your doctor to come up with a plan to help manage your condition. This will be based on how severe your ischemia is as well as what types of rehabilitation will be most effective and will make it easier for you to take charge of your heart disease and take back your health.
CVRTI
At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia. The MacLeod Lab is improving EKG detection of ischemia. The Guo Lab is understanding the process of ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it. The Donato and Lesniewski Labs are experts in vascular biology and what happens with our arteries as we age. Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia. If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.
Cardiac ischemia, also known as ischemic heart disease, is a condition where the heart muscle is deprived of blood flow due to clogged arteries. The U.S. has the second-highest mortality rate for ischemic heart disease, which makes up more than 44% of the deaths related to cardiovascular issues.
According to the CDC, 2021 saw about 695,000 deaths related to heart disease, which was actually down from 2019. However, it’s still too high, and in many cases, early diagnosis of myocardial ischemia, along with the right diagnostic approaches, can make all the difference.
What Is Cardiac Ischemia?
Cardiac ischemia may cause chest pain when you strain the body, such as when you are under excessive stress or exercising. Some people may also experience arm pain and shortness of breath during exercise or stressful periods. Other related symptoms may or may not be present.
Recognizing the Signs of Ischemia
Someone experiencing chest pains and symptoms like those listed here should seek immediate medical attention. Getting treated quickly is important, but so is getting the right heart treatment. That will involve taking an active role in learning about this condition and the different heart treatment options based on your circumstances.
Understanding Tests and Techniques
Many people wonder, what is the diagnostic test for cardiac ischemia? The short answer is that there isn’t just one “test” that can be done to determine if you have ischemic heart disease. Rather, a doctor or cardiologist will perform a series of tests based on things like:
● Medical history of a patient
● Current presentation
● Potential risk factors
● Overall health
● Lifestyle
Before the myocardial ischemia tests can begin, the doctor will need to perform a full evaluation. This may include things like:
● Questions about your symptoms, current state of health, personal history, family history, lifestyle, etc.
● Blood tests to check cholesterol levels, kidney function, blood sugar, and other important functions and levels.
● ECG or EKG tests (resting)
● Stress tests
● Imaging tests
● Angiography
All of these elements will help them determine the best course of action to get an accurate myocardial ischemia diagnosis, and then from there to create an effective treatment plan for a patient.
What Are the Diagnostic Methods for Ischemic Syndrome?
There is a long list of tests and diagnostic tools that can be used to determine all manner of heart disease conditions. However, when people ask what is the most widely used test for both diagnosis of ischemic heart disease and estimation of risk and its prognosis, the answer is simple.
The Role of Stress Testing in Ischemia Diagnosis
Stress testing is one of the most common methods that doctors use to assess and diagnose heart conditions like ischemic heart disease. There are multiple ways that this test can be performed, but the goal is the same: put the heart under as much stress as physically (or chemically) possible and see what happens.
ECG exercise testing is most common, but some people may not be capable of performing hard physical exercise. In that case, chemicals can be used to put the heart under stress and try to get a glimpse of what’s going on. This can also be paired with various imaging and testing methods to get a full image of the heart and blood vessels and how they are working (or aren’t working, in some cases).
Combining Imaging Tests with Stress Testing for Ischemia
Imaging tests and cardiac catheterization can also be effective in diagnosing cardiac ischemia and related conditions, but they are usually prefaced by the stress test because it’s the most effective tool to point people in the right direction.
Creating a Treatment Plan
Because every condition is different, the diagnosis and evaluation of your specific type and level of heart disease will help define the best course of treatment. Based on the results of the tests performed, doctors could recommend things like:
● Further, more invasive testing
● Cardiac rehabilitation, including medication management and lifestyle changes
● Non-invasive therapies
● Surgeries to remove blockages or improve blood flow
Tailoring Treatment to the Severity of Ischemia
Your doctor will work with you to come up with a treatment plan that provides the best outcome based on what type of cardiac ischemia you’re dealing with and how severe it is.
How to Improve Your Health and Reduce Risk
Many cases of ischemic heart disease can be prevented or at least put off if people are more aware of their lifestyle and choices they make. Eating healthy, maintaining a good body weight, and exercising regularly are all important to heart health. It’s also important to reduce stress, avoid smoking and alcohol, and take all prescribed medications to assist with cardiac ischemia and other conditions.
Proactive Lifestyle Changes for Heart Health
With the right testing and early diagnosis, cardiac ischemia doesn’t have to be a death sentence. Your doctor will help you make the best decisions for your care moving forward.
CVRTI
At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia. The MacLeod Lab is improving EKG detection of myocardial ischemia. The Guo Lab is understanding the process of myocardial ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it. The Donato and Lesniewski Labs are experts in vascular biology and what happens with our coronary arteries as we age. Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia. If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.
