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Reduced blood flow to the heart causes myocardial ischemia, which prevents the heart muscle from getting enough oxygen. This reduced blood flow can be caused by the partial or complete blockage of the heart arteries.
The condition known as cardiac ischemia or myocardial ischemia decreases the heart’s capacity to pump blood. A heart attack can result from a sudden, serious obstruction of a cardiac artery. Additionally, myocardial ischemia might result in dangerously irregular cardiac rhythms.
Myocardial ischemia is treated by increasing blood flow to the heart muscle. Medication, an angioplasty procedure to open blocked arteries, or bypass surgery are all possible forms of treatment.
Myocardial ischemia can be treated and prevented by adopting a heart-healthy lifestyle.
Symptoms
Myocardial ischemia can occur without any warning signs or symptoms (silent ischemia). When they do, chest pressure or pain occurs on the left side of the body (angina pectoris) is the most common symptom. Other symptoms that women, older persons, and diabetics may experience include:
- Pain on the jaw, neck, shoulder or arm
- Sweating
- Breathe shortness during exercise or activities
- The heart beats very fast
- Nausea and vomiting
- Fatigue
Two types of angina:
- Stable angina, typically stops shortly after you relax or may be managed by taking medication.
- Unstable angina, which may occur at any moment, including when you’re resting or asleep. In some cases, taking medicine won’t make it go away.
If you experience severe chest discomfort or chest pain that won’t go away, get emergency medical attention.
Causes
When the blood flow in one or more of your coronary arteries is reduced, it can cause myocardial ischemia. Your heart muscle receives less oxygen due to the reduced blood flow.
As arteries narrow over time, myocardial ischemia may gradually occur. Or, it might happen quickly if an artery suddenly becomes occluded.
The following conditions may cause myocardial ischemia:
- Coronary artery disease (atherosclerosis). The most common reason for myocardial ischemia is atherosclerosis. Your arterial walls develop plaques formed primarily of cholesterol that obstruct the blood flow.
- Blood clot. Atherosclerosis-related plaques have the chance to rupture and result in a blood clot. A heart attack could occur if the clot blocks an artery and causes abrupt, severe myocardial ischemia. Rarely, a blood clot from another part of the body may move to the coronary artery.
- Coronary artery spasm. This momentary tightening of the arterial wall muscles can shortly reduce or stop blood flow to a portion of the heart muscle.
Myocardial ischemia-related chest pain may be brought on by:
- Physical exertion
- Emotional stress
- Overconsumption of food
- Sexual intercourse
- Using cocaine
- Cold temperatures
Risk factors
Your risk of myocardial ischemia may be elevated by the following factors:
- Smoking. The inner lining of arteries can get damaged by smoking and prolonged exposure to secondhand smoke. The damage may enable the buildup of cholesterol and other material deposits, which would then impair coronary artery blood flow. Smoking can raise the risk of blood clots and cause the coronary arteries to spasm.
- Type 1 and type 2 diabetes. An increased risk of myocardial ischemia, heart attacks, and other heart issues is associated with both type 1 and type 2 diabetes.
- High blood pressure. Atherosclerosis can be sped up over time by high blood pressure, which can lead to impaired coronary artery.
- High blood cholesterol level. The deposits that can constrict your coronary arteries are largely made up of cholesterol. A diet high in saturated fats and cholesterol or a genetic disorder may both contribute to a high amount of “bad” cholesterol (Low-density Lipoprotein, or LDL) in your blood.
- High blood triglyceride level. Another type of blood fat, which may also be a factor in atherosclerosis.
- Obesity. Diabetes, high blood pressure, and high blood cholesterol are all linked to obesity.
- Waist circumference. High blood pressure, diabetes, and heart disease are all more likely in people with waists larger than 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men.
- Lack of physical exertion. Obesity and increased cholesterol and triglyceride levels are connected to insufficient exercise. Regular aerobic exercise improves heart health, which lowers the risk of myocardial ischemia and heart attacks in people. Blood pressure is also lowered by exercise.
Diagnosis
Your doctor will begin by requesting information about your medical background and performing a physical examination. Following that, your doctor might suggest:
- Electrocardiogram (ECG). The variation of the heart’s electrical activity is captured by electrodes connected to your skin, which may indicate heart damage.
- Stress test. You walk on a treadmill or ride a stationary bike while having your blood pressure, breathing, and heart rate monitored. A stress test can identify heart issues that might not otherwise be noticeable because exercise causes your heart to beat faster and harder than usual.
- Echocardiogram. A wand-like instrument is held to your chest and sound waves are aimed at your heart, creating video images of your heart. An echocardiogram can determine whether your heart has been injured and isn’t pumping properly in that area.
- Stress echocardiogram. Similar to a regular echocardiogram, a stress echocardiogram is performed following physical activity on a stationary bike or treadmill in the doctor’s office.
- Nuclear stress test. Your bloodstream will be injected with a radioactive substance to observe the flow of blood through your heart and lungs while you exercise, allowing any issues with blood flow to be found.
- Coronary angiography. Your heart’s blood vessels are injected with a dye. Following that, an angiogram (a sequence of X-ray images) is created to illustrate the dye’s route. This examination provides your doctor with a thorough view of the interior of your blood vessels.
- Cardiac computed tomography (CT) scan. This test can identify whether you have coronary atherosclerosis, which is indicated by a buildup of calcium in your coronary arteries. CT scanning can also show the cardiac arteries (coronary CT angiogram).
Treatment
Treatment for myocardial ischemia aims to increase the flow of blood to the heart muscle. Your doctor might advise drugs, surgery, or a combination of the two depending on the seriousness of your condition.
Medications
These are the medications utilized to treat myocardial ischemia:
- Aspirin. A daily dose of aspirin or another blood thinner can lower your chance of blood clots, which may help prevent coronary artery blockage. Before beginning to take aspirin, see your doctor because it may not be appropriate if you have a bleeding issue or are currently using another blood thinner.
- Nitrates. These drugs open up the arteries, enhancing the flow of blood to and from the heart. Your heart will work less hard because of improved blood flow.
- Beta blockers. These drugs lower blood pressure, relax the heart muscle, and slow the heart beat to allow for easier blood flow to the heart.
- Calcium channel blockers. These drugs relax and expand blood arteries, enhancing heart blood flow. Calcium channel blockers also lower the workload on your heart and moderate your pulse.
- Medications that lower cholesterol. These drugs lessen the main substance that builds up on the coronary arteries.
- Angiotensin-converting enzyme (ACE) inhibitors. These drugs aid in lowering blood pressure and relaxing blood arteries. If you also have diabetes or high blood pressure in addition to myocardial ischemia, your doctor may advise you to take an ACE inhibitor. ACE inhibitors may also be prescribed if you have heart failure or ineffective blood pumping from the heart.
- Ranolazine. The coronary arteries are relaxed by this medication, which reduces angina. Other angina medications like calcium channel blockers, beta blockers, or nitrates may also be prescribed along with ranolazine.
Blood flow enhancing procedures
To increase blood flow, more intense treatment is occasionally required. Techniques that could be useful include:
- Angioplasty and stenting. Your artery’s narrowed section is entered using a long, thin tube (catheter). The artery is widened by inserting a wire carrying a tiny balloon there and inflating it. To keep the artery open, a small wire mesh coil known as a stent is typically placed.
- Coronary artery bypass surgery. In order to construct a graft that permits blood to pass through the blocked or constricting coronary artery, a surgeon utilizes a vessel from another region of your body.
- Enhanced external counterpulsation. If other therapies have failed, this non-invasive outpatient treatment could be suggested. Your legs are encased in cuffs that are softly inflated with air before being deflated. Your blood vessels will be put under pressure, which could improve the flow of blood to your heart.
