Coronary ischemia

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Coronary ischemia
Synonyms	Myocardial ischemia
Pronounce	N/A
Specialty	N/A
Symptoms	Chest pain, shortness of breath, fatigue
Complications	Myocardial infarction, heart failure, arrhythmia
Onset	Sudden or gradual
Duration	Variable
Types	N/A
Causes	Atherosclerosis, coronary artery spasm
Risks	Smoking, hypertension, diabetes mellitus, hyperlipidemia, obesity, sedentary lifestyle
Diagnosis	Electrocardiogram, stress test, coronary angiography
Differential diagnosis	Gastroesophageal reflux disease, pulmonary embolism, musculoskeletal pain
Prevention	Lifestyle modification, medication
Treatment	Medication, percutaneous coronary intervention, coronary artery bypass grafting
Medication	Nitrates, beta blockers, calcium channel blockers, antiplatelet drugs
Prognosis	Variable, depends on severity and treatment
Frequency	Common, especially in older adults
Deaths	N/A

Condition of reduced blood flow to the heart muscle

Coronary ischemia is a medical condition characterized by reduced blood flow to the myocardium, the muscular tissue of the heart. This condition is often a result of coronary artery disease (CAD), where the coronary arteries become narrowed or blocked, leading to insufficient oxygen supply to the heart muscle.

Pathophysiology

Coronary arteries diagram

Coronary ischemia occurs when there is an imbalance between the oxygen supply and demand of the heart muscle. The primary cause is the narrowing of the coronary arteries due to atherosclerosis, a condition where plaque builds up on the artery walls. This narrowing reduces blood flow, especially during periods of increased demand, such as physical exertion or stress. The heart muscle requires a constant supply of oxygen-rich blood to function effectively. When the blood flow is reduced, the heart muscle may not receive enough oxygen, leading to ischemia. If the ischemia is severe or prolonged, it can result in myocardial infarction, commonly known as a heart attack.

Symptoms

The symptoms of coronary ischemia can vary depending on the severity and duration of the reduced blood flow. Common symptoms include:

• Angina pectoris: A sensation of chest pain or discomfort, often described as pressure, squeezing, or fullness in the chest. It may also radiate to the shoulders, arms, neck, jaw, or back.
• Dyspnea: Shortness of breath, especially during physical activity.
• Fatigue: Unusual tiredness or weakness.
• Palpitations: A sensation of rapid or irregular heartbeats.

In some cases, coronary ischemia may be silent, with no noticeable symptoms, particularly in individuals with diabetes mellitus.

Diagnosis

The diagnosis of coronary ischemia involves a combination of clinical evaluation, laboratory tests, and imaging studies. Common diagnostic methods include:

• Electrocardiogram (ECG): A test that records the electrical activity of the heart and can detect changes indicative of ischemia.
• Stress test: A test that evaluates the heart's function under physical stress, often using a treadmill or stationary bike.
• Cardiac catheterization: An invasive procedure that involves threading a catheter through the blood vessels to the heart to visualize the coronary arteries and assess for blockages.

Cardiac catheterization procedure

Treatment

The treatment of coronary ischemia aims to restore adequate blood flow to the heart muscle and prevent further complications. Treatment options include:

• Lifestyle modifications: Changes such as adopting a heart-healthy diet, regular exercise, smoking cessation, and weight management.
• Medications: Drugs such as beta-blockers, calcium channel blockers, nitrates, and antiplatelet agents to improve blood flow and reduce the risk of heart attacks.
• Revascularization procedures: Techniques such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) to restore blood flow to the heart.

Prevention

Preventing coronary ischemia involves managing risk factors associated with coronary artery disease. Key preventive measures include:

• Controlling hypertension and hyperlipidemia.
• Maintaining a healthy diet and regular physical activity.
• Avoiding tobacco use and limiting alcohol consumption.
• Managing diabetes and other chronic conditions effectively.

See also

• Coronary artery disease
• Myocardial infarction
• Angina pectoris
• Atherosclerosis