Myocardial ischemia
Myocardial ischemia, or cardiac ischemia, occurs when your heart muscle does not get adequate oxygen because of decreased blood flow to the heart. The reduced blood flow is due to a partial or complete coronary artery blockage from a buildup of fat and cholesterol (plaque) in the wall of an artery supplying blood to the heart. If the lack of blood to the heart lasts longer than a few minutes, the heart muscle can be damaged and die, leading to myocardial infarction or heart attack, a life-threatening medical emergency. Call an ambulance or have someone drive you to the nearest hospital immediately.
Symptoms
Myocardial ischemia occurs when the heart requires more oxygen, i.e. when you are exercising, eating, emotionally stressed, or excited than can be met by the available blood supply. The condition makes it difficult to exercise at your customary intensity. Once it progresses, you may even have symptoms at rest. Angina is a term denoting chest pain or discomfort due to myocardial ischemia.
- Angina pain is a sensation of squeezing, pressure, heaviness, tightness, burning, or pain in the chest. Some describe it as if a heavy object is sitting on the chest. The two types of anginas are
- Chronic coronary syndrome is more common and triggered by stress or exercise. It goes away with medications or resting.
- Acute coronary syndrome can arise suddenly and does not improve after taking medication.
- Pain in the upper body radiates to the jaw, neck, back, arms, left shoulder, and stomach.
- Cold sweat.
- Difficulty breathing or dyspnea.
- Dizziness.
- Feeling anxious.
- Indigestion, choking, or heartburn feeling.
- Nausea or vomiting.
- Rapid or irregular heart rhythm.
Immediately call an ambulance if you have angina or the symptoms described above for more than 5 minutes. If you think you have a heart attack, chew 5 gr. (325 mg) of aspirin which can break up the blood clots while waiting for help.
Causes
Myocardial ischemia may result from many causes.
- Coronary artery disease: The buildup of plaque can cause the narrowing of arteries so that your heart muscle does not get enough oxygen, leading to ischemia and angina.
- Coronary artery spasm
- Coronary artery dissection
- Thrombosis
- Drug abuse
Diagnosis
- Medical history taking and physical exam
- Electrocardiogram (ECG/EKG)
- Echocardiogram
- Holter monitor
- Coronary angiogram
- Chest X-ray
- Cardiac MRI
- Blood tests for cholesterol levels and troponin, a biomarker for the damaged heart muscle.
Risk factors
- Hypertension
- Hyperlipidemia
- Diabetes
- Family history of cardiovascular disease
- History of tobacco use
People with diabetes or chronic heart disease may have silent myocardial ischemia without experiencing the usual pain symptoms.
Treatment
The purpose of treatment is to increase blood circulation to the heart muscle. Which treatment modality is suitable for you depends on the cause of ischemia.
- Medications: may include antiplatelets, beta-blockers, calcium channel blockers, and nitrates
- Angioplasty and stent placement: You may need to spend a night at the hospital after this procedure.
- Coronary artery bypass graft: After the procedure, the patient usually needs one week of hospitalization, followed by 6-12 weeks of recovery at home.
Prevention
- Medication: Medications such as baby aspirin, clopidogrel, cholesterol-lowering drugs, and ACE inhibitors may be beneficial.
- Lifestyle modification
- Lifestyle changes play a crucial role in preventing the risk of developing myocardial ischemia.
- Eat more fruits, vegetables, and whole grains. Avoid saturated fat and keep your cholesterol at the recommended level.
- Exercise regularly.
- Maintain a healthy weight.
- Quit smoking and avoid secondhand smoke.
- Manage your medical condition, such asdiabetes, hypertension, and hyperlipidemia which can increase the risk of myocardial ischemia and infarction.
- Manage your stress by practicing muscle relaxation and breathing techniques.
- Have a regular medical checkup which can help you detect the disease at the early stage.
