Overview
Diagnosis
Diagnosis of myocardial ischemia usually begins with a discussion of your medical history followed by a physical examination. Based on these findings, your doctor may recommend several tests to evaluate heart function and blood flow.
An electrocardiogram records the electrical activity of the heart through electrodes placed on the skin. Certain changes in this electrical pattern may indicate heart muscle damage or reduced blood supply.
A stress test evaluates how the heart functions during physical activity. While you walk on a treadmill or ride a stationary bike, your heart rhythm, blood pressure, and breathing are monitored. Because exercise makes the heart work harder, this test can uncover heart problems that may not appear at rest.
An echocardiogram uses sound waves to create moving images of the heart. This test helps determine whether parts of the heart muscle have been damaged or are not pumping efficiently.
A stress echocardiogram combines exercise with echocardiography. The heart is imaged after physical activity to assess how well it functions when under stress.
A nuclear stress test involves injecting small amounts of radioactive material into the bloodstream. During exercise, imaging shows how blood flows through the heart and lungs, helping identify areas with poor circulation.
Coronary angiography provides a detailed look at the heart’s blood vessels. A special dye is injected into the coronary arteries, and a series of X-ray images track the dye’s flow, revealing blockages or narrowing.
A cardiac CT scan can show calcium buildup within the coronary arteries, which is a sign of coronary atherosclerosis. This test can also visualize the heart arteries using coronary CT angiography.
Treatment
The main goal of treating myocardial ischemia is to improve blood flow to the heart muscle. Depending on how severe the condition is, treatment may involve medications, procedures, or a combination of both.
Medications are commonly used to reduce symptoms and lower the risk of complications. Treatment options may include:
Aspirin or other blood thinners to reduce the risk of blood clots that can block coronary arteries
Nitrates to widen blood vessels and improve blood flow to and from the heart
Beta blockers to slow the heart rate, reduce blood pressure, and decrease the heart’s workload
Calcium channel blockers to relax and widen blood vessels while also slowing the pulse
Cholesterol-lowering medicines to reduce fatty deposits in the coronary arteries
Angiotensin-converting enzyme inhibitors to relax blood vessels and lower blood pressure, especially in people with high blood pressure, diabetes, heart failure, or reduced heart pumping ability
Ranolazine to ease chest pain by relaxing coronary arteries, often used along with other angina medicines
Procedures to improve blood flow
When medications are not enough, procedures may be needed to restore blood flow to the heart. Options may include:
Angioplasty and stenting, in which a catheter with a balloon is used to widen a narrowed artery and a stent is placed to keep it open
Coronary artery bypass surgery, where a surgeon uses a healthy blood vessel from another part of the body to reroute blood around blocked or narrowed coronary arteries. This is usually recommended for people with multiple affected arteries
Enhanced external counterpulsation, a noninvasive outpatient treatment that uses inflatable cuffs on the legs to improve blood flow to the heart when other treatments have not been effective.
Advertisement
