What is the most important medication that should be administered to a patient experiencing ischemic chest pain?

Overview

What is myocardial ischemia?

Myocardial ischemia (or cardiac ischemia) means your heart muscle is not getting enough blood (which contains oxygen and nutrients) to work as it should. If this lack of blood from your coronary arteries is severe or goes on for more than a few minutes, it can damage your heart muscle. Then it becomes a myocardial infarction (heart attack).

A heart attack is an emergency. You should call 911 for an ambulance instead of having someone drive you to the hospital.

Who does myocardial ischemia affect?

People who get myocardial ischemia often have:

• High blood pressure.
• High cholesterol.
• Diabetes.
• A family history of cardiovascular disease.
• A history of tobacco product use.

How common is myocardial ischemia?

Each year, more than 1 million people in the United States die from myocardial infarction (heart attack). This is due to myocardial ischemia, a lack of blood flow and oxygen to your heart muscle.

How does myocardial ischemia affect my body?

Myocardial ischemia makes it difficult to exercise, especially in the cold. As your condition gets worse, you can have symptoms of myocardial ischemia with less and less activity. In time, it can be hard to go up a flight of stairs. Eventually, you can even have symptoms when you’re at rest.

Symptoms and Causes

What are the symptoms?

The most common symptom of myocardial ischemia is angina (also called angina pectoris). This is chest pain (similar to indigestion or heartburn) that feels like:

• Chest discomfort.
• Heaviness.
• Tightness.
• Pressure.
• Aching.
• Burning.
• Numbness.
• Fullness.
• Squeezing.

There are two types of angina:

• Stable angina, which usually stops soon after you rest or take medication to control it.
• Unstable angina, which can happen at any time, even when you’re relaxed or sleeping. It may not go away when you take medication.

Other myocardial ischemia symptoms can also include:

• Pain or discomfort in your upper body, including your arms, left shoulder, back, neck, jaw or stomach.
• Trouble breathing or feeling short of breath.
• Sweating or "cold sweat."
• Feeling full, indigestion, or a choking feeling (may feel like heartburn).
• Nausea or vomiting.
• Feeling lightheaded, dizzy, very weak or anxious.
• Fast or irregular heartbeat.

If you have angina or any of the symptoms of ischemia listed above that last for more than five minutes, call 911 right away.

It’s possible to have ischemia ─ or even a heart attack ─ and not have any warning signs. This is called silent myocardial ischemia. This is most common in people with diabetes, but it can happen to anyone with heart disease.

What causes myocardial ischemia?

Often, a person has more than one cause of myocardial ischemia.

Causes of myocardial ischemia include:

• Coronary artery disease. This is a buildup of plaque and cholesterol inside your coronary arteries, which supply blood to your heart muscle. The buildup narrows your artery so much that the oxygen-rich blood your heart needs can’t get through, and your heart muscle becomes starved for oxygen. This causes ischemia and angina. Atherosclerotic plaque causes 70% of fatal heart attacks.
• Blood clot. When plaque that forms in your narrow coronary artery breaks apart, it can attract a blood clot. When a blood clot settles in a coronary artery that’s already narrow, it can cause a blockage (thrombosis).
• Coronary artery spasm. This happens when the coronary arteries spasm, which temporarily reduces or cuts off blood supply to your heart.
• Cocaine use.
• Coronary artery dissection. This rare condition can keep blood from getting to your heart.

Ischemia is most likely to happen when your heart needs more oxygen and nutrients than it’s getting. It happens when your heart can’t keep up with your body’s increased demand for blood.

Your body needs more blood when you’re:

• Active/exercising.
• Eating.
• Excited.
• Stressed.
• Cold.

Management and Treatment

How is myocardial ischemia treated?

Myocardial ischemia treatments may include medications or procedures to improve blood flow to your heart muscle. Your treatment for myocardial ischemia depends on the cause of the problem. Your healthcare provider will talk to you about the treatment that’s best for you.

What medications/treatments are used?

Medicines or treatments for myocardial ischemia may include:

• Nitroglycerin for quick relief of angina.
• Beta-blockers.
• Calcium channel blockers.
• Thrombolytics (clot-busting drugs).
• Angioplasty and stent placement.
• Coronary artery bypass graft.

Complications/side effects of the treatment

Complications of coronary artery bypass graft may include:

• Infection.
• Bleeding.
• Kidney failure.
• Stroke.
• Heart attack.
• Arrhythmia (abnormal heart rhythm).

Rarely, some of these complications can happen with angioplasty/ stent placement as well.

How long does it take to recover from this treatment?

After a coronary artery bypass graft, you’ll need to spend about a week in the hospital. After that, you’ll need six to 12 weeks to recover at home.

After angioplasty or stent placement, you’ll probably spend the night in the hospital and go home the next day.

Prevention

How can I reduce my risk?

Your healthcare provider may recommend medications or lifestyle changes to reduce your risk of myocardial ischemia.

Medicines

• Taking a baby aspirin (or another dose your provider suggests for you) every day to prevent a heart attack. People who can’t take aspirin can take clopidogrel.
• Beta-blockers.
• Cholesterol-lowering drugs.
• ACE inhibitors.

Lifestyle changes

• Get treatment for diabetes.
• Get treatment for high blood pressure.
• Get treatment for high cholesterol.
• Exercise 30 to 60 minutes on most days.
• Eat less fat and lots of fruits, vegetables and whole grains.
• Don’t use tobacco products.

Outlook / Prognosis

What can I expect if I have myocardial ischemia?

It’s common for people with unstable angina to have a heart attack in the next three months. Heart attacks are fatal in the first few hours for up to a third of people who have them.

Most people who get through the first few days after a heart attack recover completely. However, 10% live less than a year after their heart attack.

How long does myocardial ischemia last?

Angina from myocardial ischemia lasts 10 minutes or less in most cases.

Living With

How do I take care of myself?

Exercise is very helpful for improving your cardiovascular health. It gets more oxygen to your heart muscle, which helps with symptoms. Healthcare providers recommend getting at least 30 to 60 minutes of exercise five or more days a week.

Other ways to stay healthy include:

• Keep taking all medicines your provider prescribed for you.
• Eat a healthy diet.
• Stay at a healthy weight.
• Avoid tobacco products.

When should I see my healthcare provider?

Contact your healthcare provider if your medicines aren’t helping you or if the side effects are severe. If you’ve had an angioplasty and stent placement or coronary artery bypass graft, you’ll most likely need to see your provider every six months during the first year after your procedure.

When should I go to the ER?

Call 911 and chew an aspirin if you think you’re having a heart attack. If you have a clot in your coronary artery, aspirin can help make it smaller.

You should also get help immediately if you’ve taken three nitroglycerin doses (one every five minutes) and still have angina.

What questions should I ask my doctor?

• How often will you need to see me once I start exercising?
• Will I need to take the medicines you prescribed for the rest of my life?
• How high is my individual risk of a heart attack?

Frequently Asked Questions

Is myocardial ischemia the same as angina?

No. Angina (chest pain) is a very common symptom of myocardial ischemia.

Is myocardial ischemia a stroke?

No. Myocardial ischemia is a lack of blood supply to your heart muscle. A stroke affects your brain.

How long can you live with myocardial ischemia?

It depends on many factors, such as:

• Whether you have a heart attack.
• How quickly you get diagnosis and treatment.
• How well you do with following your healthcare provider’s instructions for making lifestyle changes.
• How well you manage conditions that cause myocardial ischemia (usually atherosclerosis).

A note from Cleveland Clinic

Chest pain from myocardial ischemia is understandably a cause for concern, but a diagnosis and treatment plan can give you peace of mind. Following your healthcare provider’s recommendations will give you the best chance of improving your heart health. Although you may not want to think about it, it’s a good idea to know the warning signs of a heart attack. Having a plan in place in case that happens will help you be prepared to help yourself or a loved one.

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