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Definitions
What is myocardial ischemia?
Myocardial ischemia occurs when blood flow stops to a part of the heart causing damage to the heart muscle. The heart requires its own constant supply of oxygen and nutrients, like any muscle in the body. Two large, branching coronary arteries deliver oxygenated blood to the heart muscle.
If one of these arteries or branches becomes blocked suddenly, a portion of the heart is starved of oxygen, a condition called “cardiac ischemia”. If cardiac ischemia lasts too long, the starved heart tissue dies.
How common is myocardial ischemia?
Myocardial ischemia is a fairly common problem associated with aging. As you get older, your risk for myocardial ischemia increases. In men, the risk increases after age 45. In women, the risk increases after age 55.
However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.
Symptoms
What are the symptoms of myocardial ischemia?
While the classic symptoms of a myocardial ischemia are chest pain and shortness of breath, the symptoms can be quite varied. The most common symptoms of a myocardial ischemia include:
- Pressure or tightness in the chest
- Pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back
- Shortness of breath
- Sweating
- Nausea
- Vomiting
- Anxiety
- A cough
- Dizziness
- A fast heart rate
It’s important to note that not all people who have myocardial ischemia experience the same symptoms or the same severity of symptoms. Chest pain is the most commonly reported symptom among both women and men. However, women are more likely than men to have:
- Shortness of breath
- Jaw pain
- Upper back pain
- Lightheadedness
- Nausea
- Vomiting
In fact, some women who have had a myocardial ischemia report that their symptoms felt like the symptoms of the flu.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consulting with your doctor immediately. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
Causes
What causes myocardial ischemia?
Plaque buildup and subsequent hardening of the arteries restricts blood flow in the arteries, preventing your organs and tissues from getting the oxygenated blood they need to function.
The following are common causes of hardening of the arteries:
- High cholesterol: Cholesterol is a waxy, yellow substance that’s found naturally in your body and also in certain foods you eat. This substance can increase in your blood and clog your arteries. It becomes a hard plaque that restricts or blocks blood circulation to your heart and other organs.
- Fat: Eating foods high in fat may also lead to plaque buildup.
- Aging: As you age, your heart and blood vessels work harder to pump and receive blood. Your arteries may weaken and become less elastic, making them more susceptible to plaque buildup.
Some other common causes are:
- Smoking and other sources of tobacco
- Insulin resistance, obesity or diabetes
- Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause
Risk factors
What increases my risk for myocardial ischemia?
These certain factors may increase your risk of having a myocardial ischemia.
- High blood pressure: You’re at greater risk for myocardial ischemia if you have high blood pressure. Normal blood pressure is below 120/80 mm Hg (millimeters of mercury) depending on your age. As the numbers increase, so does your risk of developing heart problems. Having high blood pressure damages your arteries and accelerates the buildup of plaque.
- High cholesterol levels: Having high levels of cholesterol in your blood puts you at risk for myocardial infarction. You may be able to lower your cholesterol by making changes to your diet or by taking certain medications called statins.
- High triglyceride levels: High triglyceride levels also increase your risk for having a myocardial ischemia. Triglycerides are a type of fat that clog up your arteries. Triglycerides from the food you eat travel through your blood until they’re stored in your body, typically in your fat cells. However, some triglycerides may remain in your arteries and contribute to the buildup of plaque.
- Diabetes and high blood sugar levels: Diabetes is a condition that causes blood sugar, or glucose, levels to rise. High blood sugar levels can damage blood vessels and eventually lead to coronary artery disease. This is a serious health condition that can trigger myocardial ischemia in some people.
- Obesity: Your chances of having a myocardial ischemia are higher if you’re very overweight.
- Smoking: Smoking tobacco products increases your risk for myocardial ischemia. It may also lead to other cardiovascular conditions and diseases.
- Age: The risk of having a myocardial ischemia increases with age. Men are at a higher risk of a myocardial ischemia after age 45, and women are at a higher risk of a myocardial ischemia after age 55
- Family history: You’re more likely to have a myocardial ischemia if you have a family history of early heart disease. Your risk is especially high if you have male family members who developed heart disease before age 55 or if you have female family members who developed heart disease before age 65.
- Other factors that can increase your risk for myocardial ischemia include:
- Stress
- A lack of exercise
- The use of certain illegal drugs, including cocaine and amphetamines
- A history of preeclampsia, or high blood pressure during pregnancy
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is myocardial ischemia diagnosed?
Your doctor will start with a medical history and physical exam if he or she suspects you experience myocardial ischemia. After that, your doctor might recommend:
- Electrocardiogram (ECG): The electrical activity of your heart is recorded via electrodes attached to your skin. Certain abnormalities in your heart’s electrical activity may indicate myocardial ischemia.
- Echocardiogram: Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.
- Nuclear scan: Small amounts of radioactive material are injected into your bloodstream. While you exercise, the tracer is monitored as it flows through your heart and lungs —allowing blood-flow problems to be identified.
- Coronary angiography: A dye is injected into the blood vessels of your heart. An X-ray machine then takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.
- Cardiac CT scan: This test can determine if you have coronary artery calcification. The heart arteries also can be seen using CT scanning (coronary CT angiogram).
- Stress test: Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.
How is myocardial ischemia treated?
Myocardial ischemia requires immediate treatment, so most treatments begin in the emergency room. A surgical procedure called angioplasty may be used to unblock the arteries that supply blood to the heart. During an angioplasty, your surgeon will insert a long, thin tube called a catheter through your artery to reach the blockage. They will then inflate a small balloon attached to the catheter in order to reopen the artery, allowing blood flow to resume. Your surgeon may also place a small, mesh tube called a stent at the site of the blockage. The stent can prevent the artery from closing again.
Your doctor may also want to perform a coronary artery bypass graft (CABG) in some cases. In this procedure, your surgeon will reroute your veins and arteries so the blood can flow around the blockage. A CABG is sometimes done immediately after a myocardial ischemia. In most cases, however, it’s performed several days after the incident so your heart has time to heal.
A number of different medications can also be used to treat a myocardial ischemia:
- Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries.
- Thrombolytics are often used to dissolve clots.
- Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots from forming and existing clots from growing.
- Nitroglycerin can be used to widen your blood vessels.
- Beta-blockers lower your blood pressure and relax your heart muscle. This can help limit the severity of damage to your heart.
- ACE inhibitors can also be used to lower blood pressure and decrease stress on the heart.
- Pain relievers may be used to reduce any discomfort you may feel.
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Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage myocardial ischemia?
These home remedies may help you reduce the risk of myocardial ischemias, include:
- Quit smoking: Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.
- Manage underlying health conditions: Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.
- Eat a healthy diet: Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you’ve reduced them to the recommended level.
- Exercise: Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.
- Maintain a healthy weight: If you’re overweight, talk to your doctor about weight-loss options.
- Decrease stress: Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
- It’s important to have regular medical checkups: Some of the main risk factors for myocardial ischemia — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.
If you have any questions, please consult with your doctor to better understand the best solution for you.
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