An overview of myocardial ischemia

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Myocardial ischemia does not always cause noticeable symptoms, which can make the condition more challenging to detect. Healthcare professionals may refer to this as silent ischemia.

However, when symptoms do occur, a person may experience angina. They may feel pressure, tightness, or squeezing in the chest. Sometimes, a person may feel it in the arms, shoulders, neck, jaw, or back.

Other symptoms of myocardial ischemia can include:

• shortness of breath
• fatigue
• nausea and vomiting
• sweating
• dizziness
• irregular heartbeat (arrhythmia)

Myocardial ischemia primarily occurs due to a reduction in blood flow to the heart muscle, typically due to atherosclerosis. This is a condition in which the arteries narrow and harden due to a buildup of plaque.

People who have had past heart attacks or have diabetes have a higher risk of experiencing an ischemic episode.

Other causes include:

• coronary artery disease
• coronary artery spasm
• blood clot

Several risk factors may contribute to the development of myocardial ischemia, including:

• smoking tobacco
• diabetes
• high blood pressure
• high cholesterol levels
• obesity
• low level of exercise
• stress
• family history of cardiovascular disease

Healthcare professionals may carry out several diagnostic tests, including:

• Electrocardiogram (ECG or EKG): This test records the heart’s electrical activity, helping to identify ischemic changes and irregularities in heart rhythms.
• Stress test: Including exercise and medication-based stress tests, these evaluate the heart’s performance during physical exertion or while receiving certain medications.
• Coronary CT scan: This test helps to show whether there is a buildup of calcium in the coronary arteries, which may be a sign of coronary atherosclerosis. A CT scan can also help healthcare professionals see the heart arteries. They may also perform a coronary calcium scan, which helps to assess the risk of coronary heart disease in people who do not have cardiac symptoms or those who smoke.
• Coronary angiography: This involves injecting a contrast dye into the coronary arteries to visualize blood flow and blockages via X-ray. It gives a doctor a detailed look at the inside of blood vessels.
• Cardiac MRI scan: This test helps to identify damage or issues with blood flow in the heart and the coronary arteries.
• Cardiac PET scan: This allows a healthcare professional to assess blood flow through small coronary blood vessels.

Treatment for myocardial ischemia aims to alleviate symptoms, reduce the risk of complications, and improve blood flow to the heart.

Depending on the severity of the condition, treatment options may include:

• Medications: A doctor may prescribe medications such as beta-blockers, calcium channel blockers, aspirin, or statins. Ranolazine can also help to reduce symptoms of ischemia.
• Medical procedures: To help improve blood flow, a surgeon may need to perform a heart angioplasty and stent placement or coronary artery bypass surgery. In an angioplasty, a surgeon inserts a tube into the narrowed parts of an artery and puts in a stent to keep them open. Coronary artery bypass surgery involves bypassing blocked arteries using grafts to restore blood flow to the heart muscle.

Lifestyle changes

In addition to medical interventions, a person can make certain lifestyle modifications to improve their quality of life.

• Dietary changes: Adopting a heart-healthy diet low in saturated fats, trans fats, and sodium can help manage risk factors such as high blood pressure and high cholesterol.
• Regular exercise: Engaging in regular physical activity can increase cardiovascular fitness and reduce the risk of developing obesity and diabetes.
• Quit smoking: Stopping smoking can reduce the risk of myocardial ischemia and its complications.
• Stress management: Learning stress-reduction techniques, such as meditation or yoga, can help lower the risk of stress-induced myocardial ischemia. A person may also benefit from psychotherapy to help reduce stress.

The outlook for myocardial ischemia can vary depending on several factors, including:

• how severe an artery blockage is
• how quickly a person receives a diagnosis
• whether a person follows guidance for treatment and lifestyle changes

With appropriate medical care and lifestyle changes, many people can manage their condition effectively.

A 2023 article notes that compared with those who have symptomatic ischemia, those with a history of silent myocardial ischemia have a higher relative risk of experiencing new cardiac events. However, an older 2003 article notes limited data on this topic due to the broad definition of silent ischemia.

Unmanaged myocardial ischemia can lead to severe complications, including:

• Heart attack: Ischemia can progress to a heart attack, causing permanent damage to the heart muscle.
• Heart failure: Chronic myocardial ischemia can weaken the heart over time, leading to heart failure, a condition in which the heart cannot pump blood effectively.
• Arrhythmia: An irregular heart rhythm can weaken the heart and increase the risk of stroke, which could be life threatening.

Atherosclerosis is a leading cause of myocardial ischemia. A person can take steps to lead a heart-healthy lifestyle to help prevent atherosclerosis.

A person can:

• follow a heart-healthy diet, which includes a diet consisting of fruits, vegetables, whole grains, and lean protein-rich foods
• maintain a body mass index within recommended parameters
• take part in regular physical activity
• take steps to manage stress where possible
• quit or avoid smoking
• get enough good-quality sleep
• blood pressure and cholesterol management
• diabetes management, if applicable

Regular medical checkups may also help identify risk factors early.

If a person experiences symptoms of myocardial ischemia, they should seek medical attention immediately.

It is important to pay attention to chest pain or other warning signs, as early intervention can help prevent serious complications.

Below are some frequently asked questions about myocardial ischemia.

How serious is myocardial ischemia?

Myocardial ischemia can be serious, as it can lead to heart attack and heart failure if not managed.

Is myocardial ischemia the same as heart failure?

No, they are not the same conditions. Myocardial ischemia is a condition characterized by reduced blood flow to the heart muscle, while heart failure is a chronic condition in which the heart cannot pump blood effectively.

Is myocardial ischemia reversible?

Medical intervention and management can help to ease myocardial ischemia. With medical intervention and lifestyle changes, people can manage myocardial ischemia and help prevent its progression.

Is myocardial ischemia the same as angina?

Myocardial ischemia often presents with angina as a primary symptom, but angina refers specifically to the chest discomfort associated with inadequate blood supply to the heart.

Is myocardial ischemia the same as a stroke?

Myocardial ischemia and strokes are different conditions. Myocardial ischemia involves inadequate blood flow to the heart, while a stroke is a lack of blood flow to the brain.

Myocardial ischemia is a serious cardiovascular condition characterized by reduced blood flow to the heart muscle. It can lead to angina and, in severe cases, heart attack or heart failure.

Recognizing the symptoms, addressing risk factors, seeking timely medical attention, and making necessary lifestyle changes are key to managing this condition effectively.

Individuals with myocardial ischemia can work with a doctor to improve their quality of life and reduce the risk of complications.