Nora Eccles Harrison Cardiovascular Research & Training Institute

Cardiac Ischemia

The Silent Threat: Unraveling the Hidden Dangers of Silent Myocardial Ischemia

27 September 2023
u0711090
No comments

The Silent Threat: Unraveling the Hidden Dangers of Silent Myocardial Ischemia

3d illustration human body heart

Cardiac ischemia, also known as myocardial ischemia, is a serious condition that often occurs with little to no warning. Some people don’t even experience symptoms, hence the reference to this being a “silent” threat.

Myocardial ischemia is a condition that results from a lack of proper blood flow to the heart. This is usually a result of narrowing or blockages of the arteries in the heart and can prevent the heart muscle from receiving the oxygen that it needs to function properly. In the absence of sufficient blood flow, the heart muscle can become weak.  The lack of blood flow can cause bad heart rhythms called arrhythmias which can lead to sudden death without warning.  There are several potential causes and symptoms for cardiac ischemia, which is a lot more common than you think.

What Are the Symptoms of Silent Ischemia?

The name “silent ischemia” would cause you to presume that there are no real symptoms for this condition. That is only partially true – while heart disease is a leading silent killer, there are often some symptoms or signs that people just don’t notice because they’re not connecting the dots.  Importantly, the heart muscle is unique in its ability to sense pain. If leg or arm muscles suffer ischemia (do not receive enough blood)  they will feel painful in the leg or arm respectfully. However, unlike the leg muscles, the heart muscle does not have sensory nerves to feel pain during cardiac ischemia.  Though many people may sense chest discomfort, frequently, pain from cardiac ischemia is “referred” to other parts of the body such as the jaw, arm or neck.  Many people will mistake this pain that is distant from the heart as cramping of muscle and ignore it.  Furthermore, some people will develop this condition with no obvious signs or symptoms. That’s when it is the most dangerous.

If you do have symptoms of silent myocardial ischemia, they could include things like:

  • Chest pressure or pain specifically with exertion that is relieved by rest (angina)
  • Shoulder or arm pain
  • Increased or irregular heartbeat
  • Shortness of breath
  • Nausea and vomiting
  • Fatigue and excessive tiredness
  • Sweating

You may also develop a cough or notice swelling or water retention in your legs and feet when there are underlying issues with your heart, including ischemia and other types of coronary heart disease.

If left untreated, silent myocardial ischemia can lead to a myocardial infarction (heart attack) or even death.

What Is the Silent Cause of Cardiac Ischemia?

Cardiac ischemia is caused by a partial or total blockage of the coronary arteries. This is the result of plaque buildup, which comes from factors like genetics, diet, lifestyle, and general health. When these plaques rupture, they can cause a heart attack. When the plaque builds up in the arteries over time, it causes all manner of issues, including a restriction of oxygen to the heart muscle. The heart uses much more oxygen during exercise than when resting, and sometimes when a partial blockage of a coronary artery is present there will be no symptoms at all during rest, but during exercise, when the heart requires more oxygen, the symptoms will develop.  Many people will note symptoms that start with exercise and are relieved by rest and this phenomenon is a hallmark for cardiac ischemia.

Those who smoke, are overweight, have poor diets, or have diabetes will be more likely to develop this condition, as well as those who have a genetic predisposition to heart disease. It’s important to get regular check-ups and talk to your doctor if you think something isn’t right with your health.

How Common is Silent Myocardial Ischemia?

Silent Myocardial ischemia and related chronic coronary artery disease are more common than many people think. According to the CDC, coronary heart disease is the most common type of heart condition and it killed 375,476 people in 2021. It’s estimated that one in 20 adults over the age of 20 have some form of CAD or ischemia.

The CDC also reports that someone dies of a heart attack every 40 seconds in the United States, and as many as 20% of them are silent, symptom-free, and completely unexpected. When it comes to heart disease and other conditions, the risk is real because the lack of symptoms is far more common than people realize.

What Is the Diagnosis and Treatment Like for Myocardial Ischemia?

When someone visits the doctor with concerns about their heart, the doctor will typically perform an exam that includes a variety of tests. They will perform a complete physical exam, listen to your heart and breathing, discuss your symptoms, and then determine the best tests to use. This could include:

  • Exercise stress tests
  • Heart monitors
  • ECG/EKG
  • Nuclear stress test (for those who can’t exercise)
  • Cardiac CT
  • Coronary angiography

Once the condition is diagnosed, treatment involves working to improve blood flow to your heart and reducing the blockages. This can include several interventions, such as medications, procedures, bypass surgery, and others. In severe cases, open-heart surgery may be the only option, but your doctor will be the one to determine your best treatment for myocardial ischemia.

Lifestyle changes will also help improve the heart’s health and your overall well-being. This includes exercising, eating a heart-healthy diet, and refraining from smoking, drinking, and other unhealthy habits.

Final Thoughts

Silent ischemia is a concerning thought for anyone. However, it’s usually only silent because people aren’t aware of their bodies or taking proper care of their health. Pay attention and if you notice signs of myocardial ischemia, see your doctor right away.

CVRTI Research

Investigators at the CVRTI are studying all aspects of cardiac ischemia using a collaborative bench to the bedside approach.  The Hoareau Lab studies cellular responses to cardiac ischemia in the setting of significant blood loss (hemorrhagic shock).  When someone loses a lot of blood from a gunshot wound or other trauma the heart muscle can also experience ischemia even though there are no blockages in the arteries, there is less blood and therefore less oxygen delivered to the heart muscle.    The Macleod Lab uses computers to map the electrical activity in hearts to study the electrical changes in heart muscle response to ischemia.  The TVP Lab studies how small arteries regulate oxygen delivery to heart muscle in the setting of cardiac ischemia.  The Drakos Lab through the establishment of the Utah Cardiac Recovery Program has a large bank of donated heart tissue from patients with cardiac ischemia to study the phenomenon in patients.  The state-of-the-art research at the CVRTI investigating all aspects of cardiac ischemia will lead to novel therapies to reduce mortality rate and improve survival for patients with the disease.

The state-of-the-art research at the CVRTI investigating all aspects of cardiac ischemia will lead to novel therapies to reduce mortality rate and improve survival for patients with the disease.

Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies

25 August 2023
u0711090
No comments
Categories: Blog

Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies

Heat Graphic inside of body- Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies Graphic

Cardiac ischemia is a condition that is caused by a loss of proper blood flow to the heart, usually as a result of buildup in coronary arteries which are the arteries that feed the heart. Understanding how to treat this condition and manage a healthy lifestyle can go a long way in making ischemia a less life-threatening diagnosis. Of course, every patient is different, so the treatment options can be different as well.

It’s important to manage this condition because ischemia can lead to a higher risk of heart attack and heart disease, as well as a higher risk of death due to heart disease or heart failure. To manage it, of course, you need to start by having a better understanding of cardiac ischemia and all that it can do.

Symptoms and Diagnosis

Cardiac ischemia is usually characterized by pain in the chest or shortness of breath when you perform any strenuous activity. It may also include arm pain, tingling or numbness, and other symptoms, but it’s generally a feeling of discomfort all around. For those with more severe cases, the pain may also be more severe and that could indicate that getting treatment is even more serious.

There are several different diagnostic tools used to determine if someone has ischemic heart disease. An EKG test can be performed while a person is resting. The most diagnostic non-invasive option is to do a stress test. This can be done with physical exercise, or for those who can’t exercise, a chemical based test can be performed instead.

In a stress test, the heart is put under a lot of exertion to see what it can handle. At the same time, you’re hooked up to an ECG and carefully monitored. There are also instances where imaging and other diagnostic tools are used alongside stress tests to get an accurate diagnosis.

Managing Cardiac Ischemia

So, how do you manage cardiac ischemia? Well, that depends on several factors. For starters, it will be important to consider how severe your condition is. Those who have milder forms of the disease may not need to do as much. A few simple lifestyle changes could make a big impact. For others, it might become a full-time job to manage this condition. As mentioned, education goes a long way in helping.

What is the first line of treatment for ischemic heart disease? Usually, it’s a combination of medication(s) and exercise along with lifestyle changes. Especially when the condition is caught early enough, these efforts can make big impacts. The changes that you make to your lifestyle and the medications that you need will depend on your specific circumstances, of course, so be sure to talk to your doctor and figure out what’s best.

Exercise and Rehabilitation

Medications can help, as do exercise and rehab. Physical exercise is best, at a level that is comfortable for the individual. This can help strengthen the heart muscle, and improve overall health.

What exercise is good for ischemia? Honestly, there’s a lot that you can do. Aerobic exercise is best, such as walking, biking, light jogging, or even swimming. If you want to stick to the gym, try an elliptical for low-impact, high-power cardio. Also, make sure that you stretch before and after you exercise to keep your muscles loose and help your heart maintain a regular rhythm.

Talk to your doctor because not all exercises are good for all patients when it comes to heart disease. Some people may be limited to light walks and water aerobics, for example, because they are easy and low impact.

Lifestyle Changes

There are also several lifestyle changes that you may have to undertake as part of managing cardiac ischemia. In addition to adding exercise to your daily routine (30-60 minutes per day, five days per week), you should also:

  • Eat a diet low in saturated fats, trans fats, cholesterol, and salt.
  • Eat lots of whole grains, fruits, and vegetables.
  • Reduce stress and alleviate depression.
  • Stop smoking.
  • Limit alcohol intake (or just stop).
  • Take the prescribed medications for your heart condition and other diseases.

Create Your Management Plan

The best thing that you can do if you are diagnosed with cardiac ischemia is to work with your doctor to come up with a plan to help manage your condition. This will be based on how severe your ischemia is as well as what types of rehabilitation will be most effective and will make it easier for you to take charge of your heart disease and take back your health.

CVRTI

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia.  The MacLeod Lab is improving EKG detection of ischemia.  The Guo Lab is understanding the process of ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it.  The Donato and Lesniewski Labs are experts in vascular biology and what happens with our arteries as we age.  Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia.  If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.

Cardiac Ischemia Diagnosis – Myocardial Ischemia

11 August 2023
u0711090
No comments
Categories: Blog

Cardiac Ischemia Diagnosis – Myocardial Ischemia

Multicolored Heart - Diagnostic Approaches for Cardiac Ischemia Graphic

Cardiac ischemia, also known as ischemic heart disease, is a condition where the heart muscle is deprived of blood flow due to clogged arteries. The U.S. has the second-highest mortality rate for ischemic heart disease, which makes up more than 44% of the deaths related to cardiovascular issues.

According to the CDC, 2021 saw about 695,000 deaths related to heart disease, which was actually down from 2019. However, it’s still too high, and in many cases, early diagnosis of myocardial ischemia, along with the right diagnostic approaches, can make all the difference.

What Is Cardiac Ischemia?

Cardiac ischemia may cause chest pain when you strain the body, such as when you are under excessive stress or exercising. Some people may also experience arm pain and shortness of breath during exercise or stressful periods. Other related symptoms may or may not be present.

Recognizing the Signs of Ischemia

Someone experiencing chest pains and symptoms like those listed here should seek immediate medical attention. Getting treated quickly is important, but so is getting the right heart treatment. That will involve taking an active role in learning about this condition and the different heart treatment options based on your circumstances.

Understanding Tests and Techniques

Many people wonder, what is the diagnostic test for cardiac ischemia? The short answer is that there isn’t just one “test” that can be done to determine if you have ischemic heart disease. Rather, a doctor or cardiologist will perform a series of tests based on things like:

●   Medical history of a patient

●   Current presentation

●   Potential risk factors

●   Overall health

●   Lifestyle

Before the myocardial ischemia tests can begin, the doctor will need to perform a full evaluation. This may include things like:

●   Questions about your symptoms, current state of health, personal history, family history, lifestyle, etc.

●   Blood tests to check cholesterol levels, kidney function, blood sugar, and other important functions and levels.

●   ECG or EKG tests (resting)

●   Stress tests

●   Imaging tests

●   Angiography

All of these elements will help them determine the best course of action to get an accurate myocardial ischemia diagnosis, and then from there to create an effective treatment plan for a patient.

What Are the Diagnostic Methods for Ischemic Syndrome?

There is a long list of tests and diagnostic tools that can be used to determine all manner of heart disease conditions. However, when people ask what is the most widely used test for both diagnosis of ischemic heart disease and estimation of risk and its prognosis, the answer is simple.

The Role of Stress Testing in Ischemia Diagnosis

Stress testing is one of the most common methods that doctors use to assess and diagnose heart conditions like ischemic heart disease. There are multiple ways that this test can be performed, but the goal is the same: put the heart under as much stress as physically (or chemically) possible and see what happens.

ECG exercise testing is most common, but some people may not be capable of performing hard physical exercise. In that case, chemicals can be used to put the heart under stress and try to get a glimpse of what’s going on. This can also be paired with various imaging and testing methods to get a full image of the heart and blood vessels and how they are working (or aren’t working, in some cases).

Combining Imaging Tests with Stress Testing for Ischemia

Imaging tests and cardiac catheterization can also be effective in diagnosing cardiac ischemia and related conditions, but they are usually prefaced by the stress test because it’s the most effective tool to point people in the right direction.

Creating a Treatment Plan

Because every condition is different, the diagnosis and evaluation of your specific type and level of heart disease will help define the best course of treatment. Based on the results of the tests performed, doctors could recommend things like:

●   Further, more invasive testing

●   Cardiac rehabilitation, including medication management and lifestyle changes

●   Non-invasive therapies

●   Surgeries to remove blockages or improve blood flow

Tailoring Treatment to the Severity of Ischemia

Your doctor will work with you to come up with a treatment plan that provides the best outcome based on what type of cardiac ischemia you’re dealing with and how severe it is.

How to Improve Your Health and Reduce Risk

Many cases of ischemic heart disease can be prevented or at least put off if people are more aware of their lifestyle and choices they make. Eating healthy, maintaining a good body weight, and exercising regularly are all important to heart health. It’s also important to reduce stress, avoid smoking and alcohol, and take all prescribed medications to assist with cardiac ischemia and other conditions.

Proactive Lifestyle Changes for Heart Health

With the right testing and early diagnosis, cardiac ischemia doesn’t have to be a death sentence. Your doctor will help you make the best decisions for your care moving forward.

CVRTI

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia.  The MacLeod Lab is improving EKG detection of myocardial ischemia.  The Guo Lab is understanding the process of myocardial ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it.  The Donato and Lesniewski Labs are experts in vascular biology and what happens with our coronary arteries as we age.  Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia.  If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.