Coronary ischemia

Coronary ischemia, myocardial ischemia,[1] or cardiac ischemia,[2], is a medical term for a reduced blood flow in the coronary circulation through the coronary arteries.[3] Coronary ischemia is linked to heart disease, and heart attacks.

Symptoms and signs

Symptoms of coronary ischemia can last for a short time, or for a longer time which may suggest a heart attack.[2] The main symptom is chest pain. Symptoms of coronary ischemia can be classified as typical or atypical.[2]

Typical

Chest pain is a major indication of coronary ischemia. If chest pain occurs while exercising, or during sex, but it doesn't persist after rest, it may be coronary ischemia, or what is called, angina.[2] Some people characterize the pain they feel as though an elephant is sitting on their chest. Other typical symptoms include perspiration including sweaty palms, and clammy skin, nausea or vomiting, or shortness of breath.[2] Chest pain radiating down the left arm is also a symptom, and the pain can radiate directly to the back in some instances.

Atypical

Most atypical symptoms are seen in women, diabetics, and the elderly more than anyone else.[2] These type of symptoms include stomach pain, and simply fatigue. It can also include heartburn and anxiety.[2] If no symptoms are present it is called silent ischemia.[4]

Consequences

Coronary ischemia has some serious consequences if it is not treated. It can cause high blood pressure, and high cholesterol if not treated, which can lead to a heart attack or stroke.[5] There may be temporary chest pain or angina. A heart attack can cause arrythmias, as well as permanent damage to the heart muscle.[5]

Causes

Coronary artery disease (CAD) occurs when fatty substances adhere to the walls of coronary arteries supplying the heart, narrowing them and constricting blood flow, a process known as atherosclerosis, the most common cause of coronary ischemia.[5] Lack of oxygen may also result in a myocardial infarction (heart attack).[6]

CAD can be contracted over time. Risk factors include a family history of CAD, smoking, high blood pressure, diabetes, obesity, inactive lifestyle and high cholesterol.[6]

Diagnosis

If coronary ischemia is suspected, a series of tests will be undertaken for confirmation. The most common tests used are an electrocardiogram, an exercise stress test, and a coronary angiography.[7] A medical history will be taken, including queries about past incidences of chest pain or shortness of breath. The duration and frequency of symptoms will be noted as will any measures taken to relieve the symptoms.[7]

Electrocardiogram

An electrocardiogram (ECG) involves the use of electrodes that are placed on the arms, chest, and legs.[7] These sensors detect any abnormal rhythms that the heart may be producing. This test is painless and it helps detect insufficient blood flow to the heart.[7] An ECG can also detect any damage that has been done in the past to the heart. This test can also detect any thickening in the walls of the left ventricles as well as any defects in the electrical impulses of the heart.[7] It is quick and provides the Physician with the P/PR, Heart Rate, QRS, QT/QTcF, P/QRS/T, and axis results.

Exercise stress test

A cardiac stress test, puts stress on the heart through exercise. A series of exercises to measure the tolerance for stress on the heart will be carried out. This test uses an ECG to detect the electrical impulses of the heart during physical exertion.[7]

A treadmill or exercise bike will be used. The incline or resistance of the bike are steadily increased until the target heart rate for the person's age and weight is reached.[7] However, an exercise stress test is not always accurate in determining the presence of a blockage in the arteries. Women and those who are young may show abnormalities on their test even though no signs of coronary ischemia or CAD are present.[7]

Coronary angiography

A coronary angiography is performed only after a stress test or ECG shows a sign of coronary ischemia or CAD. This test is very important in finding where the blockages are in the arteries.[7] This test helps determine if an angioplasty or bypass surgery is needed.

During this test the doctor makes a small incision in the patient's groin (femoral) or wrist (radial) and inserts a catheter. The catheter has a very small video camera on the end of it so that the doctor can find the arteries.[7] Once he has found the arteries, he injects a dye in them so that he/she can detect any blockages in the arteries. The dye is able to be seen on a special x-ray machine.[7] The test takes one to two hours.

Treatment

Coronary ischemia can be treated but not cured.[8] By changing lifestyle, further blockages can be prevented. A change in lifestyle, mixed with prescribed medication, can improve health.

Not smoking

A study showed that those who quit smoking reduced their risk of being hospitalized over the next two years.[8] Smoking increases blood pressure, as well as increases the risk of high cholesterol. Quitting can lower blood pressure, and triglyceride levels. Secondhand smoke is also bad for the heart health.[8]

Healthy diet

A healthy diet is a very important factor in preventing coronary ischemia or coronary artery disease.[8] A heart healthy diet is low in saturated fat and cholesterol and high in complex carbohydrates.[8] Complex carbohydrates include fruits, vegetables, and whole grains. These food choices can reduce the risk of a heart attack or any other congestive heart failure event.[8] A heart healthy diet also includes low sodium intake and a higher potassium intake.[8] A low potassium intake raises blood pressure, as does a diet high in sodium.

Physical activity

By increasing physical activity, it is possible to manage body weight, reduce blood pressure, and relieve stress.[8] The Center for Disease Control recommends 30 minutes of physical activity a day.[8] Instead of 30 minutes a day at one time, short bursts of physical activity for 8–10 minutes three times a day are also suitable. Exercising this way can reduce the risk of getting heart disease or coronary ischemia, if it is performed at moderate intensity.[8]

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References
  1. "Myocardial ischemia". Mayo Clinic. Retrieved 2019-11-29.
  2. Potochny, Evy. "Cardiac Ischemia Symptoms." LiveStrong. Demand Media, 9 March 2010. Web. 6 Nov. 2010.
  3. "Sacred Heart Medical Center. Spokane, Washington. Coronary Ischemia". Shmc.org. Retrieved 2008-12-28.
  4. "Silent Ischemia and Ischemic Heart Disease". www.heart.org.
  5. ["Ischemia." Ischemic Heart Disease. Ischemic Heart Disease, n.d. Web. 6 Nov. 2010.]
  6. [RelayHealth. "Coronary Artery Disease." Adult Health Advisor (July 2009): 1. Consumer Health Complete. Web. 4 Nov. 2010.]
  7. [Gerstenblith, Gary, and Simeon. Margolis. "Diagnosis of Coronary Heart Disease." Hopkins Heart (Jan. 2008): 18-25. Consumer Health Complete. Web. 17 Nov. 2010.]
  8. [Gerstenblith, Gary, and Simeon Margolis. "Lifestyle Measures to Prevent and Treat Coronary Artery Disease." Hopkins Heart (Jan. 2008): 25-36. Consumer Health Complete. Web. 29 Nov. 2010.]
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