Cardiac Ischemia: Symptoms, Causes & Treatment

Cardiac ischemia is a decrease in oxygen-rich blood flow to the heart muscle, also called the myocardium. It can cause symptoms such as chest pain, a burning feeling in the chest, heart palpitations, shortness of breath, and a general feeling of being unwell.

It is most commonly caused by coronary artery disease (CAD), in which fatty plaque builds up inside the coronary arteries and can eventually rupture or block blood flow.

Treatment for cardiac ischemia is guided by a cardiologist. It may include medications to improve blood flow to the heart, along with cholesterol management, reduced salt intake, and regular physical activity.

Main symptoms

The main symptoms of cardiac ischemia are:

• Chest pain or a burning feeling that may spread to the neck, jaw, shoulders, or arms

• Heart palpitations

• Chest pressure

• Shortness of breath or difficulty breathing

• Nausea and a general feeling of being unwell

• Cold sweats

• Pale skin

However, cardiac ischemia may not cause any symptoms and may only be found during a routine exam or after it causes a heart attack. According to the American Heart Association, silent ischemia occurs when blood flow to the heart is reduced without obvious symptoms.

If you have symptoms of cardiac ischemia, go to the emergency room immediately or call 911.

How cardiac ischemia happens

According to the American Heart Association, coronary artery disease can develop gradually as plaque narrows the coronary arteries, or it can occur acutely when a plaque suddenly ruptures and a blood clot forms.

This can reduce blood flow to the heart muscle and lead to a heart attack or serious arrhythmias. When this happens, the heart may not pump blood effectively, leading to symptoms.

Confirming a diagnosis

Cardiac ischemia is diagnosed by a cardiologist based on symptoms, medical history, cardiovascular history, a physical exam, lab tests, and imaging tests.

The doctor may order blood tests to check cholesterol, triglycerides, blood sugar, and cardiac enzyme levels.

Other tests may include an electrocardiogram (ECG), exercise stress test, echocardiogram, myocardial perfusion scan, or cardiac catheterization to confirm cardiac ischemia.

Possible causes

The main causes of cardiac ischemia are:

• Atherosclerosis

• Coronary artery spasms

• Coronary embolism

• Cardiac trauma

• Aortic stenosis

However, other conditions can also lead to cardiac ischemia, such as lupus, diabetes, syphilis, obstructive sleep apnea (OSA), very severe hyperthyroidism, and drug use, such as cocaine or amphetamines.

Some factors can also increase the risk of cardiac ischemia, such as high cholesterol and triglycerides, uncontrolled high blood pressure, physical inactivity, smoking, obesity, and excess visceral fat.

Main types

Cardiac ischemia can be classified into different types. The main types are:

1. Stable angina

Stable angina is a type of chronic but temporary ischemia. Chest pain usually appears during physical effort, emotional stress, or after eating, and improves within a few minutes or with rest.

However, if it is not treated, it can lead to a heart attack.

2. Unstable angina

Unstable angina is also a type of chronic ischemia. However, chest pain can appear at any time, last longer than 20 minutes, and does not improve with rest.

If it is not treated quickly, it can progress to a heart attack.

3. Acute myocardial infarction

An acute myocardial infarction, or heart attack, can occur when angina worsens. It may also happen suddenly, without warning.

Symptoms of a heart attack include intense chest pain or burning that does not improve, pain that may spread to the arm, shoulders, or neck, shortness of breath, or cold sweats. It should be treated as soon as possible in the emergency room.

4. Silent ischemia

Silent ischemia is reduced blood flow through the coronary arteries without noticeable symptoms. It is often found during routine testing and can increase the risk of a heart attack or sudden cardiac arrest.

Treatment options

Treatment for cardiac ischemia should be guided by a cardiologist. The goal is to improve blood flow to the heart, reduce coronary artery spasms, and prevent complications.

The main treatments for cardiac ischemia are:

1. Medications

Medications for cardiac ischemia vary depending on severity, symptoms, and whether it is acute or chronic. The main medications are:

• Antiplatelet medications, such as aspirin

• Nitrates, such as nitroglycerin

• Beta blockers, such as atenolol, bisoprolol, metoprolol, or nebivolol

• Calcium channel blockers, such as verapamil or diltiazem

• Statins, such as simvastatin, atorvastatin, or rosuvastatin

• Vasodilators, such as isosorbide

These medications should be used only as prescribed by a cardiologist. Ranolazine may also be prescribed together with other medications to treat chronic angina.

Conditions such as high cholesterol, high blood pressure, diabetes, and sleep apnea should also be controlled, as they can increase the risk of cardiac ischemia.

2. Lifestyle changes

Lifestyle changes, such as eating a healthy, well-balanced diet and doing doctor-approved physical activity, can help lower cholesterol and manage diabetes or high blood pressure. This can reduce the risk of cardiac ischemia and related complications.

It is also important to limit alcohol, sugar, and fatty or processed foods, quit smoking, and reduce stress.

3. Surgery

In more severe cases, when medications are not enough, the cardiologist may recommend surgery or procedures such as angioplasty, with or without stent placement.

Another option is coronary artery bypass graft (CABG) surgery, which may use a blood vessel such as the saphenous vein to bypass a blocked coronary artery.

Can cardiac ischemia be cured?

Cardiac ischemia does not have a definitive cure, but symptoms can be controlled with treatment prescribed by a cardiologist. Treatment can also improve quality of life and help prevent complications.

Possible complications

Cardiac ischemia can lead to complications such as acute myocardial infarction (heart attack), cardiac arrhythmias, or heart failure.

Seek medical care immediately if symptoms of cardiac ischemia occur. Regular follow-up with a cardiologist is also important, especially for people with angina or risk factors for cardiac ischemia.