Myocardial ischemia

Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend:

• Electrocardiogram (ECG). Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart's electrical activity may be a sign of heart damage.
• Stress test. Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.
• Echocardiogram. Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn't pumping normally.
• Stress echocardiogram. A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor's office on a treadmill or stationary bike.
• Nuclear stress test. Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs — allowing blood-flow problems to be identified.
• Coronary angiography. A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye's path. This test gives your doctor a detailed look at the inside of your blood vessels.
• Cardiac CT scan. This test can determine if you have a buildup of calcium in your coronary arteries — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both.

Medications

Medications to treat myocardial ischemia include:

• Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you're already taking another blood thinner.
• Nitrates. These medications widen arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn't have to work as hard.
• Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.
• Calcium channel blockers. These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.
• Cholesterol-lowering medications. These medications decrease the primary material that deposits on the coronary arteries.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels and lower blood pressure. Your doctor might recommend an angiotensin-converting enzyme (ACE) inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia. ACE inhibitors may also be used if you have heart failure or if your heart doesn't pump blood effectively.
• Ranolazine (Ranexa). This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.

Procedures to improve blood flow

Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:

• Angioplasty and stenting. A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.
• Coronary artery bypass surgery. A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.
• Enhanced external counterpulsation. This noninvasive outpatient treatment might be recommended if other treatments haven't worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart.

Lifestyle changes are an important part of treatment. To follow a heart-healthy lifestyle:

• Quit smoking. Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.
• Manage underlying health conditions. Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.
• Eat a healthy diet. Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you've reduced them to the recommended level.
• Exercise. Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.
• Maintain a healthy weight. If you're overweight, talk to your doctor about weight-loss options.
• Decrease stress. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

It's important to have regular medical checkups. Some of the main risk factors for myocardial ischemia — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.

If you are experiencing chest pain, you likely will be examined and treated in the emergency room.

If you don't have chest pain but are having other symptoms, or are concerned about your risk of myocardial ischemia, you might be referred to a heart specialist (cardiologist).

What you can do

• Be aware of any pre-appointment restrictions, such as fasting before a blood test.
• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Write down questions to ask your doctor.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

• What's the most likely cause of my symptoms?
• What tests do I need? Is there any special preparation for them?
• What kinds of treatments do I need?
• Should I make any lifestyle changes? What would be an appropriate diet and level of activity for me?
• How frequently should I be screened for heart disease?
• I have other health problems. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

• What are your symptoms, and when did they begin?
• How severe are your symptoms? Are they occasional or continuous?
• Does anything improve or worsen your symptoms?
• Do you have a family history of heart disease, high blood pressure or high cholesterol?
• Do you or did you smoke?