Abstract

Coronary ischemia is a medical term for not having enough blood through the coronary arteries. Coronary ischemia is linked to heart disease as well as heart attacks. It is also known as cardiac ischemia.

Causes

Coronary artery disease (CAD) occurs when fatty substances get stuck to the walls of coronary arteries, which narrows the arteries and constricts blood flow. This causes a lack of oxygen and blood to the heart, which can result in a myocardial infarction (heart attack). CAD leads to constricted arteries, which leads to a lack of blood flowing through the arteries as well as oxygen, a process called atherosclerosis. Atherosclerosis is the most common cause of coronary ischemia.

CAD can be contracted over time. Certain factors play into this, for example, a family history of CAD. Other factors include smoking, high blood pressure, diabetes,obesity, inactive lifestyle and high cholesterol.

Symptoms

The symptoms of coronary ischemia can last for a short period of time. The other symptoms that last for a longer period of time may suggest a myocardial infarction.

Symptoms of coronary ischemia can be classified as typical or atypical.

Symptoms | 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". Some people characterize the pain they feel as though an elephant is sitting on their chest.

Other typical symptoms include diaphoresis which is sweaty palms, and clammy skin, nausea or vomiting, or shortness of breath. Chest pain radiating down the left arm is also a symptom of coronary ischemia and the pain can also be radiating directly to the back in some instances.

Symptoms | Atypical

Most atypical symptoms are seen in women, diabetics, and the elderly more than anyone else.

These type of symptoms include stomach pain, and simply fatigue. It can also include heartburn and anxiety.

If no symptoms are present it is called silent ischemia.

Diagnosis

If there is a suspicion that one may have coronary ischemia, a doctor will administer a series of tests to confirm the diagnosis.. The most common tests today are an electrocardiogram, an exercise stress test, and a coronary angiography.

The doctor will also ask a series of questions to determine the medical history of the patient, including past incidences of chest pain or shortness of breath. He may also inquire about the duration of symptoms, how often they occur and any measures taken in attempts to relieve them.

Diagnosis | Electrocardiogram

When a doctor performs an electrocardiogram (ECG) s/he places small sensors on the arms, chest and legs.

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.

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.

It is quick and provides the Physician with the P/PR, Heart Rate, QRS, QT/QTcF, P/QRS/T, and axis results.

Diagnosis | Exercise stress test

A stress test, is just that, a test to put stress on the heart through exercise. A doctor will put a patient through a series of exercises to measure the tolerance for stress on the heart. This test uses an ECG to detect the electrical impulses of the heart during physical exertion.

During this test a patient is put on a treadmill or a stationary bike. The incline or resistance of the bike are steadily increased until the patient reaches the target heart rate for the patient's age and weight.

An exercise stress test is not always accurate in determining if one has 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.

Diagnosis | 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.

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.

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.

The test takes one to two hours.

Side effects

Coronary ischemia has some serious side effects if it is not treated. It can cause the increased risk of high blood pressure, and high cholesterol. If not treated, these can both lead to a heart attack.

When the coronary arteries become constricted, it can lead to a heart attack. One can suffer temporary chest pain or angina. A heart attack can cause arrythmias, as well as permanent damage to the heart muscle.

If left untreated, coronary ischemia can also lead to a stroke.

Treatment and prevention

Coronary ischemia can be treated but not cured.

By changing lifestyle, further blockages can be prevented. A change in lifestyle, mixed with prescribed medication, can improve health.

Treatment and prevention | Not smoking

A study showed that those who quit smoking reduced their risk of being hospitalized over the next two years.

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.

Treatment and prevention | Healthy diet

Diet is a very important factor in getting coronary ischemia or coronary artery disease and preventing it.

A heart healthy diet is low in saturated fat and cholesterol and high in complex carbohydrates.

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.

A heart healthy diet also includes low sodium intake and a higher potassium intake. A low potassium intake raises blood pressure, as does a diet high in sodium.

Treatment and prevention | Physical activity

By increasing physical activity, it is possible to manage body weight, reduce blood pressure, and relieve stress.

The Center for Disease Control recommends 30 minutes of physical activity a day.

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.