Cardiac Ischemia

Cardiac Ischemia: Overview

Alternative names: Myocardial Ischemia, Silent Ischemia, Ischemia, Ischaemia

Cardiac Ischemia occurs when blood flow through one or more of the three coronary arteries is decreased for a short time, reducing the supply of oxygen-rich blood to the heart.  The most common symptom is chest pain (angina pectoris).

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Just like any other muscle in the body, the heart requires a steady supply of oxygen and nutrients, delivered via the bloodstream.  As with other muscles, an interruption of this supply leads to pain and reduced function.

Cardiac Ischemia a common cause of chest pain, shortness of breath, and cardiac arrhythmias in adults.  Angina (angina pectoris) is the term for chest pain that is thought to be caused by Cardiac Ischemia.  In cases of "Silent Ischemia", the chest pain is absent but other symptoms (such as exertional shortness of breath, nausea, sweating, fatigue) may be present.

Incidence; Causes and Development; Contributing Risk Factors

The American Heart Association in 2015 estimated that 3-4 million Americans experience Ischemia.

Cardiac Ischemia – and consequently angina – occurs whenever the heart muscle's oxygen requirement exceeds supply due to reduced blood flow to the heart.  This is usually caused by a partial or complete blockage of the coronary arteries and can happen gradually over a long period of time, or suddenly.  Causative conditions include:

  • Coronary artery disease (atherosclerosis): This is the most common cause, in which cholesterol builds up on the artery walls and restricts blood flow.
  • Blood clot
  • Coronary artery spasm: An uncommon cause, in which a temporary tightening of the muscles in an artery wall can briefly decrease or halt blood flow to part of the heart muscle.

Those with diabetes or a history of heart attacks are especially at risk for developing Ischemia.  Heart muscle disease (cardiomyopathy) caused by Ischemia is a leading cause of heart failure.

The following factors can increase one's risk of developing Ischemia:

  • Coronary Artery Disease
  • Coronary Artery Anomalies
  • Cardiomyopathy
  • Tobacco Smoke increases the risk of blood clot formation and damages artery walls which can increase cholesterol deposits.
  • Diabetes (types 1 and 2) is associated with various heart problems.
  • Hypertension (high blood pressure) can accelerate the atherosclerotic process.
  • A High Blood Cholesterol Level helps form plaques which narrow the arteries.
  • A High Blood Triglyceride Level contributes to atherosclerosis.
  • Being Overweight can lead to diabetes, hypertension and high blood cholesterol levels.
  • Alcohol
  • Drug Use
  • A Sedentary Lifestyle can lead to obesity and high cholesterol and triglyceride levels.

Signs and Symptoms

In cases of Silent Ischemia, there may be no obvious symptoms at all.  A patient with episodes of noticeable chest pain may also have episodes of Silent Ischemia.

When symptoms are present, the most common is chest pain, usually on the left side of the chest, also known as angina pectoris.  This chest pain can be triggered by things such as physical exertion, stress, cold weather, or cocaine use.

Other symptoms can include:

Diagnosis and Tests

Rapid diagnosis is desirable in order to reduce the likelihood of morbidity and mortality.

An exercise stress test can show any insufficient flow through the coronary arteries.  A Holter monitor records heart data over a 24-hour period (or longer) and can detect episodes of ischemia.

Treatment and Prevention

The goal of treatment is to improve blood flow to the heart, either through medication or surgery.

Medications include aspirin, anticoagulants, other blood-thinning agents, and those which slow the heart rate, relax and dilate blood vessels, and reduce the stresses on the heart.

Oxygen may be given to increase the oxygen content of the blood and painkillers may be used against the pain.

Surgical procedures include balloon angioplasty and coronary artery bypass surgery.

Preventive measures include:

  • Stopping smoking
  • Improving diet to control cholesterol
  • Controlling diabetes, if it is present
  • Controlling hypertension, if it is present
  • Regular exercise, which also helps prevent hypertension
  • Limiting alcohol intake

Complications; Seek medical attention if...

Cardiac Ischemia can lead to an irregular heartbeat; disturbances to the heart's rhythm can damage the heart muscle and reduce its pumping capacity, potentially leading to fainting or even sudden heart tissue death.  If the blockage is severe or prolonged, it can cause a heart attack (myocardial infarction).

Seek immediate emergency care if you have prolonged or severe chest pain.

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Cardiac Ischemia:

Signs, symptoms & indicators of Cardiac Ischemia:

Symptoms - General


Hiccups usually last for only a few minutes, but can persist for days – or even months in rare cases.  Although usually benign, they can sometimes be an indicator of underlying metabolic or infectious processes, including heart disease.

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