Medical & Legal Information on Myocardial Ischemia: Causes & Treatment Options
• Myocardial Ischemia Overview
• Myocardial Ischemia Symptoms
• Myocardial Ischemia Causes
• Risk Factors
• Myocardial Ischemia Complications
• Treating Myocardial Ischemia
• Preventing Myocardial Ischemia
Myocardial Ischemia Overview
Myocardial Ischemia (cardiac ischemia) can develop quickly when the flow of blood to the heart is reduced. This action involves a complete or partial block of the coronary arteries (heart arteries) and prevents the delivery of oxygen to the heart muscle. The result usually causes significant damage to the heart muscle and reduces the organ’s capacity to pump efficiently. Severe sudden blocks of blood flow through the coronary arteries often produces heart attacks (myocardial infarction) and severe abnormal heart rhythms.
Statistics collected and released by the CDC (Centers for Disease Control and Prevention) reveals that one heart attack occurs every 43 seconds in the United States, affecting more than 735,000 Americans every year. Of these heart attacks, 525,000 occurred individuals who have never had a heart attack before. Their numbers also suggest that 20 percent of all heart attacks occurring in the US are silent where the individual is unaware of the damage that has been caused by the attack.
Myocardial ischemia can also cause an imbalance that occurs between oxygen demand and myocardial blood flow. This condition often presents itself as chest pain among individuals suffering from CAD (coronary artery disease), which affects nearly 10 million men and women in the United States annually.
Myocardial Ischemia Symptoms
Many individuals who have experienced ischemia do not present any symptoms of the condition (silent ischemia). However, when the symptoms do happen, they usually present as pain or chest pressure, typically occurring on the body’s left side (angina pectoris). However, women, individuals with diabetes and older people will experience symptoms that include:
- Jaw or neck pain
- Fast heart rate
- Vomiting and nausea
- Physically active-associated shortness of breath
- Arm or shoulder pain
Severe or prolonged chest pain usually requires immediate medical attention.
Myocardial Ischemia Causes
Doctors and researchers have long known that myocardial ischemia is the result of a partial or complete blockage of the flow of blood through one or more coronary arteries. The diminished rate of blood decreases the oxygenation received by the heart muscle. While the condition can occur suddenly, it also develops slowly as the blockage in the artery builds up over time. Common conditions associated with myocardial ischemia include:
- Coronary Artery Spasm – Artery muscles that temporarily tighten can prevent or decrease the flow of blood to the heart muscle and often cause a coronary artery spasm leading to myocardial ischemia.
- Blood Clot – This condition is developed by accumulating plaques on the interior of the arteries that over time can rupture, leading to a blood clot that surrounds the released plaque. The clot has the potential of blocking blood flow in the artery, leading to a severe common sudden myocardial ischemia and eventually a heart attack. On rare occasions, the blood clot will travel from the coronary artery into other areas of the body.
- Atherosclerosis (Coronary Artery Disease) – Cholesterol and other properties of the body can cause the buildup of plaque on the artery walls that eventually restricts blood flow. The condition is the most common cause of severe and mild myocardial ischemia.
Scientists of research have long known that there are significant risk factors for the development of myocardial ischemia that include:
- Tobacco Use – Smoking cigarettes, cigars and other tobacco products along the long-term exposure to secondhand smoke are known to cause significant damage to the artery’s interior walls. Over time, the cholesterol deposits collect in the coronary arteries and slow the flow of blood. Smoking has also been associated with increased potential development of blood clots in coronary arteries.
- Type I and Type II Diabetes – Diabetes has a direct correlation to the increased risk of developing heart problems including myocardial ischemia and heart attacks.
- High Blood Pressure – Over the arc of an individual’s life, elevated blood pressure can accelerate the development of atherosclerosis that will eventually lead to damaged coronary arteries.
- High Levels of Blood Triglyceride – Blood fats including triglycerides are known to contribute to the development of atherosclerosis where plaque builds up inside coronary arteries.
- Waist Circumference – Waists that measure 35 inches (89 centimeters) or more in women and 40 inches (102 centimeters) or more in men are known to increase the potential risk of developing heart disease and high blood pressure.
- Obesity – Being excessively overweight has been directly linked with the development of diabetes, high blood cholesterol levels, and high blood pressure.
- High Levels of Blood Cholesterol – Studies show the deposits that narrow coronary arteries are primarily made up of cholesterol, where significant levels of low-density lipoprotein (LDL – “bad”) cholesterol could be caused by a diet high levels of cholesterol and saturated fats or as a condition inherited from ancestors.
- Lack of Physical Activity – Living a sedentary lifestyle that results in obesity, which has a direct link to high triglyceride and cholesterol levels. Alternatively, individuals participating in routine aerobic exercise have significantly healthier cardiovascular fitness, which is known to decrease the potential of developing heart attacks and myocardial ischemia, while lowering high blood pressure.
Myocardial Ischemia Complications
Serious complications can be the result of myocardial ischemia that includes:
- Heart Failure – Damage to the heart muscle can occur during myocardial ischemia, and reduce the capacity of the heart to pump blood efficiently throughout the body. The condition can also damage the heart muscle to the point of partial or complete failure.
- Arrhythmia (Irregular Heart Rhythm) – Myocardial ischemia can produce an abnormal heart rhythm that over time weakens the heart, causing a life-threatening condition.
- Heart Attack – Myocardial ischemia can cause the coronary arteries to become completely or partially blocked, depriving the heart muscle of much-needed oxygen. Over time, the condition can destroy portions of the heart muscle and possibly lead to a fatal outcome.
Diagnosing myocardial ischemia requires a comprehensive physical exam and a complete medical history. The doctor will likely recommend numerous tests that include:
- ECG (electrocardiogram)
- EKG (echocardiogram)
- Tilt Table Test
- Myocardial Biopsy
- Heart MRI
- Pericardial Tab
- Nuclear Scan
- Coronary Angiography
- Cardiac CT Scan
- Stress Test
Treating Myocardial Ischemia
Doctors might recommend one or more treatment options that can improve the flow of blood to the heart muscle. The type of treatment usually depends on the severity of the condition and may require surgery, drugs or both. Common treatment and medications include:
- Beta blockers
- Calcium Channel Blockers
- ACE inhibitors
- Cholesterol-lowering drugs
- Ranexa (ranolazine)
- Stenting and angioplasty
- Coronary artery bypass surgery
- Enhanced external counterpulsation
Preventing Myocardial Ischemia
Making significant changes in lifestyle habits can help treat and prevent myocardial ischemia. Some of these lifestyle changes can ensure that the arteries remain strong, smooth and elastic to allow for a maximum amount of flow through the arteries to the heart muscle. These lifestyle changes include:
- Smoking cessation – quit smoking
- Consume a healthy diet
- Manage underlying health problems
- Decrease stress
- Maintain a healthy weight
- Exercise on a routine basis
Myocardial ischemia is a silent killer and requires that the individual obtains routine medical checkups to rule out diabetes, high blood pressure, and high cholesterol. Early detection followed by an effective treatment is an ideal solution for maintaining better heart health.