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MYOCARDIAL ISCHEMIA

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MYOCARDIAL ISCHEMIA

Myocardial ischemia occurs when blood flow to the heart is restricted, preventing the heart muscle from receiving enough oxygen.

  • The heart receives its own blood supply from the coronary arteries, which transports blood into and out of the heart muscles
  • The 2 main coronary arteries are the left main which supplies blood to the left side of the heart (the left ventricle and left atrium) and the right coronary artery which supplies blood to the right ventricle, right atrium, and the sinoatrial and atrioventricular nodes
  • The reduced blood flow as seen in myocardial ischemia is usually the result of a partial or total blockage of the heart’s arteries (coronary arteries)
  • This blockage narrows the artery so much that the oxygen-rich blood needed by the heart can’t get through, resulting in the heart muscle being starved of oxygen
  • Myocardial ischemia can develop slowly or can occur quickly when an artery gets blocked suddenly
  • This blockage can lead to a heart attack and possibly death

CAUSES

Conditions that can cause myocardial ischemia includes:

  • Coronary artery disease, where plaque made up mostly of fat builds up in the artery walls and reduce blood flow. This is the most common cause of myocardial ischemia
  • Blood clots
  • Coronary spasms, which occurs as a result of the tightening of the artery wall. This can briefly reduce or prevent blood flow to part of the heart muscles

Factors that can increase the risk of getting the condition include:

  • Family history of coronary heart disease
  • Tobacco smoking
  • Diabetes
  • High blood pressure
  • Sedentary lifestyle
  • Obesity
  • High blood cholesterol level
  • High blood triglyceride levels
  • End-stage kidney disease
  • Alcohol or drug abuse
  • A waist circumference of more than 35 inches for women and 40 inches for men. This increases the risk of high blood pressure, diabetes, and heart disease

SYMPTOMS

Some people don’t have symptoms, known as silent ischemia. When symptoms occur, they include:

  • Chest pressure or pain (angina)
  • A fast heartbeat
  • Fatigue
  • Sweating
  • Neck or jaw pain
  • Shoulder or arm pain
  • Shortness of breath when physically active
  • Nausea and vomiting

Chest pain associated with myocardial ischemia can be triggered by:

  • Emotional stress
  • Cold temperatures
  • Cocaine use
  • Physical exertion
  • Sexual intercourse
  • Eating a heavy or large meal

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will review your medical history and carry out a physical examination.

After that, the doctor might recommend:

  • Electrocardiogram to record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage
  • Echocardiogram to produce visual images of your heart. This can help identify whether an area of your heart has been damaged and isn’t pumping normally
  • Stress test to monitor your heart rhythm, blood pressure, and breathing while you walk on a treadmill or ride a stationary bike. This can help to detect any heart problems
  • Coronary angiography gives the doctor a detailed look at the inside of your blood vessels. During this test, a dye is injected into the blood vessels of your heart and a series of X-ray images are taken showing the dye’s path
  • Cardiac CT scan to determine if you have a buildup of calcium in your coronary arteries
  • Nuclear stress test to identify any blood-flow problems. During this test, small amounts of radioactive material are injected in your bloodstream and the doctor watches as the material flows through your heart and lung while you exercise
  • Myocardial biopsy to collect and analyze a small tissue sample from the heart muscle
TREATMENT

The goal of treatment is to improve blood flow to the heart muscle. Treatment options include:

Medications, such as aspirin, beta blockers, calcium channel blockers, cholesterol-lowering medications, nitrates, ranolazine, and angiotensin-converting enzyme (ACE) inhibitors.

Some more aggressive treatment may be needed to improve blood flow. This may include:

  • Atherectomy to remove plaque from the arteries
  • Balloon angioplasty and stenting to widen and keep the arteries open
  • Coronary artery bypass surgery where a vessel from another part of the body is used to create a graft that allows blood to flow around the blocked or narrowed artery. This is usually done for people with severe narrowed coronary artery.