Coronary ischemia

Coronary ischemia is a medical condition characterized by reduced blood flow to the heart muscle, leading to a mismatch between myocardial oxygen demand and supply. This condition is primarily caused by obstruction or narrowing of the coronary arteries, which supply blood, oxygen, and nutrients to the heart muscle. Coronary ischemia is a key component of coronary artery disease (CAD), which is the most common type of heart disease and a leading cause of death worldwide.

Causes

The primary cause of coronary ischemia is atherosclerosis, a process in which plaque (made up of fat, cholesterol, calcium, and other substances found in the blood) builds up on the inner walls of the coronary arteries. This buildup can restrict blood flow or, in some cases, lead to complete blockage. Other causes may include coronary artery spasm, a temporary tightening of the muscles within the artery walls, and embolism, where a blood clot or other foreign matter blocks the artery.

Symptoms

Symptoms of coronary ischemia can vary but often include chest pain or discomfort (angina pectoris), shortness of breath, fatigue, and palpitations. Angina is typically described as a pressure, heaviness, tightness, or pain in the chest and can be precipitated by physical exertion or emotional stress. In some cases, coronary ischemia may be silent, occurring without any noticeable symptoms.

Diagnosis

Diagnosis of coronary ischemia involves a combination of patient history, physical examination, and diagnostic tests. Common tests include the electrocardiogram (ECG), which can detect abnormalities in the heart's electrical activity; stress testing, to assess heart function under physical stress; and imaging tests such as coronary angiography, which visualizes the inside of the coronary arteries, and cardiac MRI or CT scans, which provide detailed images of the heart and blood vessels.

Treatment

Treatment for coronary ischemia focuses on improving blood flow to the heart muscle and may include lifestyle changes, medication, and procedures to restore blood flow. Lifestyle changes involve a heart-healthy diet, regular exercise, smoking cessation, and weight management. Medications commonly used include antiplatelet drugs (such as aspirin), statins to lower cholesterol, beta-blockers to reduce heart workload, and nitrates to widen blood vessels. In more severe cases, procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be necessary to improve blood flow.

Prevention

Preventing coronary ischemia involves managing risk factors for coronary artery disease. This includes controlling high blood pressure, high cholesterol, diabetes, maintaining a healthy weight, avoiding tobacco, and engaging in regular physical activity.

See Also

• Myocardial infarction
• Heart failure
• Cardiovascular disease
• Atherosclerosis