Myocardial ischemia

Diagnosis

Your doctor will begin by requesting information about your medical background and performing a physical examination. Following that, your doctor might suggest:

• Electrocardiogram (ECG). The variation of the heart’s electrical activity is captured by electrodes connected to your skin, which may indicate heart damage.
• Stress test. You walk on a treadmill or ride a stationary bike while having your blood pressure, breathing, and heart rate monitored. A stress test can identify heart issues that might not otherwise be noticeable because exercise causes your heart to beat faster and harder than usual.
• Echocardiogram. A wand-like instrument is held to your chest and sound waves are aimed at your heart, creating video images of your heart. An echocardiogram can determine whether your heart has been injured and isn’t pumping properly in that area.
• Stress echocardiogram. Similar to a regular echocardiogram, a stress echocardiogram is performed following physical activity on a stationary bike or treadmill in the doctor’s office.
• Nuclear stress test. Your bloodstream will be injected with a radioactive substance to observe the flow of blood through your heart and lungs while you exercise, allowing any issues with blood flow to be found.
• Coronary angiography. Your heart’s blood vessels are injected with a dye. Following that, an angiogram (a sequence of X-ray images) is created to illustrate the dye’s route. This examination provides your doctor with a thorough view of the interior of your blood vessels.
• Cardiac computed tomography (CT) scan. This test can identify whether you have coronary atherosclerosis, which is indicated by a buildup of calcium in your coronary arteries. CT scanning can also show the cardiac arteries (coronary CT angiogram).

Treatment

Treatment for myocardial ischemia aims to increase the flow of blood to the heart muscle. Your doctor might advise drugs, surgery, or a combination of the two depending on the seriousness of your condition.

Medications

These are the medications utilized to treat myocardial ischemia:

• Aspirin. A daily dose of aspirin or another blood thinner can lower your chance of blood clots, which may help prevent coronary artery blockage. Before beginning to take aspirin, see your doctor because it may not be appropriate if you have a bleeding issue or are currently using another blood thinner.
• Nitrates. These drugs open up the arteries, enhancing the flow of blood to and from the heart. Your heart will work less hard because of improved blood flow.
• Beta blockers. These drugs lower blood pressure, relax the heart muscle, and slow the heart beat to allow for easier blood flow to the heart.
• Calcium channel blockers. These drugs relax and expand blood arteries, enhancing heart blood flow. Calcium channel blockers also lower the workload on your heart and moderate your pulse.
• Medications that lower cholesterol. These drugs lessen the main substance that builds up on the coronary arteries.
• Angiotensin-converting enzyme (ACE) inhibitors. These drugs aid in lowering blood pressure and relaxing blood arteries. If you also have diabetes or high blood pressure in addition to myocardial ischemia, your doctor may advise you to take an ACE inhibitor. ACE inhibitors may also be prescribed if you have heart failure or ineffective blood pumping from the heart.
• Ranolazine. The coronary arteries are relaxed by this medication, which reduces angina. Other angina medications like calcium channel blockers, beta blockers, or nitrates may also be prescribed along with ranolazine.

Blood flow enhancing procedures

To increase blood flow, more intense treatment is occasionally required. Techniques that could be useful include:

• Angioplasty and stenting. Your artery’s narrowed section is entered using a long, thin tube (catheter). The artery is widened by inserting a wire carrying a tiny balloon there and inflating it. To keep the artery open, a small wire mesh coil known as a stent is typically placed.
• Coronary artery bypass surgery. In order to construct a graft that permits blood to pass through the blocked or constricting coronary artery, a surgeon utilizes a vessel from another region of your body.
• Enhanced external counterpulsation. If other therapies have failed, this non-invasive outpatient treatment could be suggested. Your legs are encased in cuffs that are softly inflated with air before being deflated. Your blood vessels will be put under pressure, which could improve the flow of blood to your heart.