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Myocardial ischemia

Myocardial ischemia occurs when blood flow to your heart muscle is decreased by a partial or complete blockage of your heart's arteries (coronary arteries). The decrease in blood flow reduces your heart's oxygen supply.

Myocardial ischemia, also called cardiac ischemia, can damage your heart muscle, reducing its ability to pump efficiently. A sudden, severe blockage of a coronary artery may lead to a heart attack. Myocardial ischemia may also cause serious abnormal heart rhythms.

Treatment for myocardial ischemia is directed at improving blood flow to the heart muscle and may include medications, a procedure to open blocked arteries or coronary artery bypass surgery. Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.

Symptoms Causes Risk factors Complications Prevention

Some people who have myocardial ischemia don't experience any signs or symptoms (silent ischemia). When myocardial ischemia does cause signs and symptoms, they may include:

  • Chest pressure or pain, typically on the left side of the body (angina pectoris)
  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath
  • Nausea and vomiting

When to see a doctor

If you have chest discomfort, especially if it's accompanied by one or more of the other signs and symptoms listed above, seek medical care immediately. Call emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.

Myocardial ischemia occurs when the blood flow through one or more of the blood vessels that lead to your heart (coronary arteries) is decreased. This decrease in blood flow leads to a decrease in the amount of oxygen your heart muscle (myocardium) receives. Myocardial ischemia may occur slowly as arteries become blocked over time, or it may occur quickly when an artery becomes blocked suddenly.

Conditions that may cause myocardial ischemia include:

  • Coronary artery disease (atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and waste products build up on your artery walls and restrict blood flow. Atherosclerosis of the heart arteries is called coronary artery disease and is the most common cause of myocardial ischemia.
  • Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot, which may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
  • Coronary artery spasm. A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle.

Things that may trigger chest pain associated with myocardial ischemia include:

  • Physical exertion
  • Emotional stress
  • Cold temperatures
  • Lying down
  • Cocaine use

Myocardial ischemia occurs when the blood flow through one or more of the blood vessels that lead to your heart (coronary arteries) is decreased. This decrease in blood flow leads to a decrease in the amount of oxygen your heart muscle (myocardium) receives. Myocardial ischemia may occur slowly as arteries become blocked over time, or it may occur quickly when an artery becomes blocked suddenly.

Conditions that may cause myocardial ischemia include:

  • Coronary artery disease (atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and waste products build up on your artery walls and restrict blood flow. Atherosclerosis of the heart arteries is called coronary artery disease and is the most common cause of myocardial ischemia.
  • Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot, which may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
  • Coronary artery spasm. A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle.

Things that may trigger chest pain associated with myocardial ischemia include:

  • Physical exertion
  • Emotional stress
  • Cold temperatures
  • Lying down
  • Cocaine use

Factors that may increase your risk of developing myocardial ischemia include:

  • Tobacco. Both smoking and long-term exposure to secondhand smoke can damage the interior walls of arteries — including arteries in your heart — allowing deposits of cholesterol and other substances to collect and slow blood flow. Smoking also increases the risk of blood clots forming in the arteries that can cause myocardial ischemia.
  • Diabetes. Diabetes is the inability of your body to adequately produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Both type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.
  • High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure is more common in those who are obese. Eating a diet high in salt also may increase your risk of high blood pressure.
  • High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of "bad" (low-density lipoprotein, or LDL) cholesterol in your blood is linked to an increased risk of atherosclerosis and myocardial ischemia. A high LDL level may be due to an inherited condition or a diet high in saturated fats and cholesterol. A high level of triglycerides, another type of blood fat, may also contribute to atherosclerosis. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
  • Lack of physical activity. An inactive lifestyle contributes to obesity and is associated with higher cholesterol and triglycerides and an increased risk of atherosclerosis. People who get regular aerobic exercise have better cardiovascular fitness, which is associated with a decreased risk of myocardial ischemia and heart attack. Exercise also lowers high blood pressure.
  • Obesity. Obese people have a high proportion of body fat, often with a body mass index of 30 or higher. Obesity raises the risk of myocardial ischemia because it's associated with high blood cholesterol levels, high blood pressure and diabetes.
  • Waist circumference. A waist circumference of more than 35 inches (88 centimeters) for women and 40 inches (102 cm) or more in men increases the risk of heart disease.
  • Family history. If you have a family history of heart attack or coronary artery disease, you may be at increased risk of myocardial ischemia.

Myocardial ischemia can lead to a number of serious complications, including:

  • Heart attack (myocardial infarction). If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle, causing serious and in some cases fatal heart damage.
  • Irregular heart rhythm (arrhythmia). Your heart muscle needs sufficient oxygen to beat properly. When your heart doesn't receive enough oxygen, the electrical impulses in your heart that coordinate your heartbeats may malfunction, causing your heart to beat too fast, too slow or irregularly. In some cases, arrhythmias can be life-threatening.
  • Heart failure. Myocardial ischemia can damage the heart muscle itself, leading to a reduction in its ability to effectively pump blood to the rest of your body. Over time, this damage may lead to heart failure.

The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow. To follow a heart-healthy lifestyle, you should:

  • Avoid secondhand smoke and quit smoking or chewing tobacco
  • Control conditions such as high blood pressure, high cholesterol and diabetes
  • Exercise
  • Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains
  • Maintain a healthy weight
  • Reduce and manage stress
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