Coronary ischemia

Coronary ischemia is a medical term for not having enough blood through the coronary arteries.^[1] Coronary ischemia is linked to heart disease as well as heart attacks.It is also known as cardiac ischemia.^[2]

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).^[3] CAD leads to constricted arteries, which leads to a lack of blood flowing through the arteries as well as oxygen, a process called atherosclerosis.^[4] Atherosclerosis is the most common cause of coronary ischemia.^[4]

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.^[3]

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.^[2] Symptoms of coronary ischemia can be classified as typical or atypical.^[2]

Typical Symptoms

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.^[2] 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.^[2]

Atypical Symptoms

Most atypical symptoms are seen in woman, diabetics, and the elderly more than anyone else.^[2] These type of symptoms include stomach pain, and simply fatigue. It can also include heartburn and anxiety.^[2] 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 test to be sure that is what you have. The most common tests today are an electrocardiogram, an exercise stress test, and a coronary angiography.^[5] The doctor will also ask you a series of questions about your medical history. He may ask you if you have a chest pain or shortness of breath in the past. He may also ask you how long your symptoms last, how often they occur and how you may relieve them.^[5]

Electrocardiogram

When your doctor performs an electrocardiogram (ECG) he places small metal sensors on your arms, chest and legs.^[5] These metal sensors detect any abnormal rhythms that your heart may be producing. This test is painless and it helps detect insufficient blood flow to the heart.^[5] An ECG can also detect any damage that has been done in the past to your 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.^[5]

Exercise stress test

The name of this test almost explains itself. A doctor will put you through a series of exercises to measure your tolerance for stress on your heart. This test uses an ECG to detect the electrical impulses of your heart during physical exertion.^[5]

During this test you are put on a treadmill or a stationary bike. The incline or resistance of the bike are steadily increased until you reach your target heart rate for your age and weight.^[5] An exercise stress test is not always accurate in determining if one has a blockage in their arteries. Those who are young and are women may show abnormalities on their test even though no signs of coronary ischemia or CAD are present.^[5]

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.^[5] 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 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.^[5] 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.^[5] 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.^[4] One can suffer temporary chest pain or angina. A heart attack can cause arrythmias, as well as permanent damage to the heart muscle.^[4] If left untreated, coronary ischemia can also lead to a stroke.

Treatment and prevention

Coronary ischemia can be treated but not cured.^[6] By changing lifestyle, further blockages can be prevented. A change in lifestyle mixed with prescribed medication, can greatly improve health.

Smoking

A study showed that those who quit smoking reduced their risk of being hospitalized over the next two years.^[6] 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.^[6]

Healthy diet

Diet is a very important factor in getting coronary ischemia or coronary artery disease and preventing it.^[6] A heart healthy diet is low in saturated fat and cholesterol and high in complex carbohydrates.^[6] 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.^[6] A heart healthy diet also includes low sodium intake and a higher potassium intake.^[6] A low potassium intake raises blood pressure. The same goes with sodium.

Physical activity

By increasing physical activity it's possible to manage body weight, reduce blood pressure, and relieve stress. ^[6] The Center for Disease Control recommends 30 minutes of physical activity a day.^[6] 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.^[6]

References

1. ^ "Sacred Heart Medical Center :: Spokane, Washington :: Coronary Ischemia ::". Shmc.org. http://www.shmc.org/index.php/conditions/561. Retrieved 2008-12-28. 
2. ^ ^{a b c d e f g} [Potochny, Evy. "Cardiac Ischemia Symptoms." LiveStrong. Demand Media, 9 Mar. 2010. Web. 6 Nov. 2010.
3. ^ ^{a b} [RelayHealth. "Coronary Artery Disease." Adult Health Advisor (July 2009): 1. Consumer Health Complete. Web. 4 Nov. 2010.]
4. ^ ^{a b c d} ["Ischemia." Ischemic Heart Disease. Ischemic Heart Disease, n.d. Web. 6 Nov. 2010.]
5. ^ ^{a b c d e f g h i j k} [Gerstenblith, Gary, and Simeon. Margolis. "Diagnosis of Coronary Heart Disease." Hopkins Heart (Jan. 2008): 18-25. Consumer Health Complete. Web. 17 Nov. 2010.]
6. ^ ^{a b c d e f g h i j} [Gerstenblith, Gary, and Simeon Margolis. "Lifestyle Measures to Prevent and Treat Coronary Artery Disease." Hopkins Heart (Jan. 2008): 25-36. Consumer Health Complete. Web. 29 Nov. 2010.]