What is cardiac ischemia?

Cardiac ischemia occurs when blood flow to the heart muscle (myocardium) is
decreased by a partial or complete blockage of a coronary artery. A sudden, severe
blockage may lead to a heart attack (myocardial infarction). Cardiac ischemia may
also cause a serious abnormal heart rhythm (arrhythmia), which can cause fainting
or even sudden death.
What Is Myocardial Ischemia?
More than 6 million Americans live with myocardial ischemia, or angina. The
term refers to chest pain or discomfort that occurs when the heart muscle is
not getting enough oxygen-rich blood for a short period of time. The
inadequate blood flow is caused by narrowed coronary arteries, which are the
vessels that supply blood to the heart. A bout of myocardial ischemia is not
a heart attack, but it means that you're more likely to have a heart attack
than someone who doesn't have myocardial ischemia.

Understanding the Heart and Coronary Arteries

In order to understand the cause of myocardial ischemia, it is often helpful to
understand the heart and the coronary arteries. Like any muscle, the heart
needs a constant supply of oxygen and nutrients, which are carried to it by
the blood in the coronary arteries. Similar to other muscles, the harder the
heart is working, the more oxygen and nutrients it needs. However, the
coronary arteries can become narrowed or clogged, which can decrease the
amount of blood that goes to the heart muscle. When the coronary arteries
cannot supply enough oxygen-rich blood to the heart, symptoms of
myocardial ischemia can occur.

Types of Myocardial Ischemia

There are three types of myocardial ischemia:

• Stable
• Unstable
• Variant (also known asPrinzmetal's angina).

Stable Myocardial Ischemia

Stable myocardial ischemia is the most common type. It occurs when the
heart is working harder than usual. There is a regular pattern to this
condition. After several episodes, you learn to recognize the pattern and can
predict when it will occur. The pain usually goes away in a few minutes after
you rest or take your medicine.
Unstable Myocardial Ischemia
Unstable myocardial ischemia is a dangerous condition that requires
emergency treatment. It is a sign that a heart attack could occur soon.
Unlike stable myocardial ischemia, it does not follow a pattern. It can occur
without physical exertion and is not relieved by rest or medicine.

Variant Myocardial Ischemia

Variant myocardial ischemia is rare; it usually occurs at rest. The pain
associated with this can be severe, and usually occurs between midnight and
early morning. This pain can usually be relieved by medicine.

What Causes It?

As mentioned, myocardial ischemia is caused by a temporary lack of oxygen-
rich blood to the heart muscle. This decrease in blood flow can happen for a
number of reasons and will vary based on the type. In most cases, the cause
of myocardial ischemia is coronary artery disease(CAD), or what most
people refer to as just heart disease. Sometimes, other types of heart
disease (such as aortic stenosis) or uncontrolledhigh blood
pressure (hypertension) can cause it.

Triggers of Myocardial Ischemia

For a lot of people (especially those with stable myocardial ischemia),
symptoms are triggered by:

• Physical exertion, such as exercise, hurrying, or sexual activity

• Emotion (stress, anger, frustration, or fright)
• Exposure to very hot or cold temperatures
• Heavy meals
• Smoking.

Unstable and variant myocardial ischemia are usually not associated with
triggers.
Know the Risk Factors
Specific risk factors for myocardial ischemia include:

• Coronary artery disease, also known as coronary heart disease

• Other heart diseases, such as aortic stenosis or hypertrophic
cardiomyopathy
• Previous heart attack
• Age.

Stable and unstable myocardial ischemia occur more often in older adults.
People with variant myocardial ischemia are often younger than those with
other forms of the condition.

Symptoms of Myocardial Ischemia

People experiencing a myocardial ischemia attack usually feel discomfort
(often a pressure-like pain) in or around the:

• Chest
• Shoulders
• Jaw
• Neck
• Back
• Arms.

It may feel like a squeezing, pressing sensation in the chest. This pain
usually lasts two to five minutes.

Other symptoms can include:

• Indigestion or heartburn-type sensation

• Nausea
• Fatigue
 • Shortness of breath
• Sweating
• Lightheadedness
• Weakness.

Not all chest pain is myocardial ischemia. Several other conditions can cause
chest discomfort or pain, such as:

• Heartburn
• Stomach ulcers
• Panic attack
• Muscle problems
• Pneumonia
• Heart attack
• Inflammation around the heart.

Myocardial Ischemia Versus a Heart Attack

An episode of myocardial ischemia is not a heart attack, but it does mean
that you have a greater chance of having a heart attack. The pain associated
with myocardial ischemia means that some of the heart muscle temporarily is
not getting enough blood. A heart attack, on the other hand, occurs when the
blood flow to a part of the heart is suddenly and permanently cut off, usually
by a blood clot. This can lead to serious heart damage.

There are some serious symptoms that indicate you are having a heart
attack. If you have any of these symptoms, call 911 immediately:

• Pain or discomfort that is very bad, gets worse, and lasts longer
than 20 minutes
• Pain or discomfort along with weakness, feeling sick to your
stomach, sweating, or fainting
• Pain or discomfort that does not go away when you
take anginamedicine
 • Pain or discomfort that is worse than you have ever had before.

Symptoms of Myocardial Ischemia

People experiencing a myocardial ischemia attack usually feel discomfort
(often a pressure-like pain) in or around the:

• Chest
• Shoulders
• Jaw
• Neck
• Back
• Arms.

It may feel like a squeezing, pressing sensation in the chest. This pain
usually lasts two to five minutes.

Other symptoms can include:

• Indigestion or heartburn-type sensation

• Nausea
• Fatigue
• Shortness of breath
• Sweating
• Lightheadedness
• Weakness.

Not all chest pain is myocardial ischemia. Several other conditions can cause
chest discomfort or pain, such as:

• Heartburn
• Stomach ulcers
• Panic attack
 • Muscle problems
• Pneumonia
• Heart attack
• Inflammation around the heart.

Myocardial Ischemia Versus a Heart Attack

An episode of myocardial ischemia is not a heart attack, but it does mean
that you have a greater chance of having a heart attack. The pain associated
with myocardial ischemia means that some of the heart muscle temporarily is
not getting enough blood. A heart attack, on the other hand, occurs when the
blood flow to a part of the heart is suddenly and permanently cut off, usually
by a blood clot. This can lead to serious heart damage.

There are some serious symptoms that indicate you are having a heart
attack. If you have any of these symptoms, call 911 immediately:

• Pain or discomfort that is very bad, gets worse, and lasts longer
than 20 minutes
• Pain or discomfort along with weakness, feeling sick to your
stomach, sweating, or fainting
• Pain or discomfort that does not go away when you
take anginamedicine
• Pain or discomfort that is worse than you have ever had before.