Tokuda Hospital Sofia


Ischaemic Heart Disease

Look for a doctor if the chest pain doesn’t fade away in 10 minutes. It could be a heart attack.

What is Ischaemic Heart Disease

Ischaemic Heart Disease (IHD) is a disease affecting the heart vessels, and more specifically – its arteries. It is closely related to the atherosclerosis, which leads to changing of the vessels – most often their lumen narrows and this can lead to their blockage. This disrupts the blood flow to the heart muscle (myocardium), which is related to the appearing of different symptomatic. The isheamia itself means inadequate oxygen supply of the tissues.

Which are the risk factors

The causes of the atherosclerosis are not known, but some risk factors for its developing are established: arterial hypertension, diabetes, smoking, dislipidemia (disorder of the fats metabolism in the blood, especially cholesterol and triglycerides). If these are present, the risk for atherosclerosis, and relatively the risk for IHD, is increased. Build-ups begin to pile up in the vessels, forming plaques. After they reach a certain quantity, they begin to grow towards the vessel and gradually they block its lumen. This happens in all the arteries – heart, brain, limbs, kidneys. When the heart vessels are affected, an Ishaemic Heart Disease appears.

The plaques can develop fluently and increase the disease symptoms, but they can also appear suddenly: they can break down and their contents can flow into the blood vessel, which causes thrombosis. It’s possible for the plaque itself to damage the surface of the vessel and to form a thrombosis, which leads to sudden blockage of the vessel – a heart attack.

Both sexes are equally affected by atherosclerosis and IHD, but typical for the feminine gender is the protective action of the female sex hormones. That’s why we begin to think about these diseases for men at the age of 45-50, and for women – about 10 years later, after the menopause. The IHD appears more often with getting on the age, but it’s not an exception for young people also, and especially for those with a combination of risk factors – for e.g. genetically conditioned diabetes and severe dislipidemia.

What  are the symptoms

IHD can go without symptoms, as well as with dramatic appearance – sudden heart death. In other words, a man can have many manifestations of atherosclerosis with narrowing and vessel blockages but with no symptoms at all and at the same time the first manifestation can be the sudden heart death. In this broad spectrum the most frequent manifestation of the IHD is angina pectoris, commonly known as angina - appearing of chest pain, most often provoked by physical efforts and emotional stress.

Usually this pain is felt behind the chest bone, covering broad area of the body spreading from the zone to the left arm, the jaw and the throat. It is constant with duration 5-10 minutes. In chronic form of angina pectoris the pain fades away or is relieved by calming down. A nitroglycerin pill under the tongue can also help. The pain can be also atypical – only in the arm or the elbow like formication of the left arm, arrhythmia, it can be accompanied with pain high in the stomach. Suffocation and shortage of air are sure indications for angina pectoris. The acute coronary syndrome (heart attack or pre-infarction condition) is much more dramatic pain, which goes suddenly and is combined with nausea, vomiting, sweating. It continues even when calming down and lasts for longer. In any case pain that manifests for the first time and lasts more than 5-10 minutes, or is strong and appears during low physical intensity or lasts longer, is  worrying and it is strongly recommended to see a doctor. Thus an acute myocardium syndrome can be excluded or a fast invasive cardiology can be performed to recover the passability of the blocked vessel. The purpose is to save the heart muscle and to keep its function and this can happen if emergency measures are taken in 6 to 12 hours. In the first 6 hours the heart muscle can be helped the most if its blood circulation is recovered. Then the consequences of the infarction are not that fatal. The conservative (medicine) treatment of IHD includes controlling of the risk factors – the arterial hypertension, diabetes and high cholesterol levels, but should go in parallel with changing the way of life, removing the bad habits and diet. It can be combined with medicines, affecting the certain complaints. The third type of treatment, applied by the cardiologists, is the invasive one, called revascularization or overcoming of the vessel blockages. This overcoming can be done either with going through the narrow parts or blockages (dilating or installing cardiac stents), or with a bypass (bypassing the blockage) in advanced stage of the disease.

What is allowed and what is forbidden

The patient should discuss with his cardiologist what and how he/she might do. First he/she should talk with him about the regimen they must comply with, including diet. Second, it must be cleared out, what physical activities he/she might have. They are recommended, even strongly, except for extreme ones and only if they are conformed to the particular patient’s condition. Of course, not in the acute stage of infarction, but generally regular physical activities are very helpful. Their influence is beneficial for the cardio-vascular system itself, as well as for limiting the effects of the risk factors. In this connection pressure related to having sex is also allowed. The intake of anabolic steroids is not recommended for the people exercising in gym, but they are not recommended for healthy people either. Climbing high altitudes and flying with planes are acceptable as far as the disease is not in a very advanced stage.

Smoking, especially when high cholesterol levels are present, should be avoided, as well as excessive usage of alcohol. Food rich in animal fats should be limited, especially: pork, full fat milk, fat salty sausages, eggs, yellow cheese.

 Fish is very healthy because of the omega-3 fatty acids, which act beneficially over the metabolism of cholesterol. Veal and poultry can be eaten, as well as lots of fruits and vegetables. A glass of wine or two are healthy.




Cardiology Consultations

In-patinet Care

Angiographic Labs


Risk factors and behaviou…

Ischaemic Heart Disease



Hospital location

51B Nikola Y. Vaptsarov Blvd., Sofia, 1407 (if you drive, the entrance is from Atanas Dukov str.)

The hospital has a parking lot for patients and visitors. The first 30 min. are free of charge, every next hour is 3BGN/hrs.
IMPORTANT! Have in mind that the parking lot is very busy Monday to Friday between 10.00 and 14.00. The hospital team will appreciate if those whose health condition allow, take the drop off option without parking or use other transport means or alternative parking lots in the area.

Public transport:
Buses: №88, 120

Metro lines: You can get off at James Bourchier or Vitosha metro station and walk to the hospital.


From the Central Railway Station

Bus: take bus #305 and get off at Romanian Embassy stop, then transfer to bus #120 to Tokuda Hospital stop.

Metro: Take metro line Nadezda-Lozenetz and get off either at James Bourchier or Vitosha metro station, then walk to the hospital.