SYMPTOMS OF MYOCARDIAL ISCHEMIA

Myocardial ischemia occurs when blood flow to your heart muscle is decreased by a partial or complete blockage of your heart’s arteries (coronary arteries). The decrease in blood flow reduces your heart’s oxygen supply.
Some people who have myocardial ischemia don’t experience any signs or symptoms (silent ischemia).
When myocardial ischemia does cause signs and symptoms, they may include:
-Chest pressure or pain, typically on the left side of the body (angina pectoris)
-Neck or jaw pain
-Shoulder or arm pain
-A fast heartbeat
-Shortness of breath
-Nausea and vomiting

When to see a doctor?
If you have chest discomfort, especially if it’s accompanied by one or more of the other signs and symptoms listed above, seek medical care immediately. Call 911 or your local emergency number. If you don’t have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.






I HAD A HEART ATTACK WITHOUT KNOW IT?

A silent heart attack is a heart attack that has few, if any, symptoms. You may have never had any symptoms to warn you that you’ve developed a heart problem, such as chest pain or shortness of breath. Some people later recall their silent heart attack was mistaken for indigestion, nausea, muscle pain, or a bad case of the flu.
The risk factors for having a silent heart attack are the same as having a heart attack with symptoms. The risk factors include:
-Smoking or chewing tobacco
-Family history of heart disease
-High cholesterol
-Diabetes
-Lack of exercise
-Being overweight

Having a silent heart attack puts you at a greater risk of having another heart attack, which could be fatal. Having another heart attack also increases your risk of complications, such as heart failure.
If you wonder if you’ve had a silent heart attack, talk to your doctor. A review of your symptoms, health history and a physical exam can help your doctor decide if more tests are necessary. The only way to tell if you’ve had a silent heart attack is to have additional tests, such as an electrocardiogram, echocardiogram or other imaging tests. These tests can reveal changes that signal you’ve had a heart attack.






A HEART ATTACK WITHOUT KNOW IT?

When you have a heart attack, you know it because the main symptom—crushing chest pain—is overwhelmingly obvious. That’s what most of us believe about heart attacks. But it’s not always true.
What few people realize: Studies show that 20% to 60% of all heart attacks in people over age 45 are unrecognized or “silent.” And the older you are, the more likely it is that you’ve already had a silent heart attack. In a study of 110 people with a mean age of 82, an astounding 68% had suffered a silent heart attack.
What happens during a silent heart attack? You may have no symptoms at all. Or you may have symptoms that are so mild—for example, a bout of breathlessness, digestive upset or neurological symptoms such as fainting—that neither you nor your doctor connects them with a heart attack.
Scientists don’t know why some people have unrecognized heart attacks. But they do know that a silent heart attack is a real heart attack and can cause as much damage to heart muscle as a non-silent heart attack. And just like a person with a known heart attack, anyone who has had a silent heart attack is at higher risk for another heart attack, heart failure, stroke… or sudden death from an irregular heartbeat.
Recent scientific evidence: In a six-year study by cardiologists from the University of California in San Diego and San Francisco—published in Clinical Research in Cardiology in April 2011—people who were diagnosed with a silent heart attack at the beginning of the study were 80% more likely to have another “cardiovascular event,” such as a heart attack or stroke, by the end of the study period.
In a five-year study by cardiologists at the Mayo Clinic, people with an unrecognized heart attack were seven times more likely to die of heart disease than people who didn’t have an unrecognized heart attack.






WHAT IS A SILENT HEART ATTACK?

A silent heart attack is a heart attack that has few, if any, symptoms. You may have never had any symptoms to warn you that you’ve developed a heart problem, such as chest pain or shortness of breath. Some people later recall their silent heart attack was mistaken for indigestion, nausea, muscle pain, or a bad case of the flu.
The risk factors for having a silent heart attack are the same as having a heart attack with symptoms. The risk factors include:
-Smoking or chewing tobacco
-Family history of heart disease
-High cholesterol
-Diabetes
-Lack of exercise
-Being overweight

Having a silent heart attack puts you at a greater risk of having another heart attack, which could be fatal. Having another heart attack also increases your risk of complications, such as heart failure.
If you wonder if you’ve had a silent heart attack, talk to your doctor. A review of your symptoms, health history and a physical exam can help your doctor decide if more tests are necessary. The only way to tell if you’ve had a silent heart attack is to have additional tests, such as an electrocardiogram, echo-cardiogram or other imaging tests. These tests can reveal changes that signal you’ve had a heart attack.






A HEART ATTACK WITH NOT WARNING

Ischemia is a condition where the flow of oxygen-rich blood to a part of the body is restricted. Cardiac ischemia refers to lack of blood flow and oxygen to the heart muscle. It occurs when an artery becomes narrowed or blocked for a short time, preventing oxygen-rich blood from reaching the heart. If ischemia is severe or lasts too long, it can cause a heart attack (myocardial infarction) and can lead to heart tissue death. In most cases, a temporary blood shortage to the heart causes the tremendous pain of angina pectoris. Patients with silent ischemia have pain-free ischemia. It is dangerous because it may cause a heart attack with no prior warning.
How Common is Silent Ischemia and Who is at Risk?
The American Heart Association estimates that 3 to 4 million Americans have episodes of silent ischemia. People who have had previous heart attacks or those who have diabetes are especially at risk for developing silent ischemia. Heart muscle disease (cardiomyopathy) caused by silent ischemia is among the more common causes of heart failure in the United States.
Major risk factors include:
• Previous heart attack
• Coronary artery disease
• Diabetes
• High blood pressure (hypertension)
• Cardiomyopathy
• Obesity
• Smoking
• Alcohol and drug abuse

Symptoms- Silent ischemia has no symptoms. Researchers have found that patients who have noticeable chest pain may also have episodes of silent ischemia.






The Ischemic Foot

The term “ischemic foot” refers to a lack of adequate arterial blood flow from the heart to the foot. There are a wide variety of possible causes for poor arterial circulation into the foot including arterial blockage from cholesterol deposits, arterial blood clots, arterial spasm, or arterial injury. The ischemic foot is also referred to as having arterial insufficiency, meaning there is not enough blood reaching the foot to provide the oxygen and nutrient needs required for the cells to continue to function.
Diagnosis
The result of insufficient blood supply to the foot can manifest itself in a variety of ways depending upon how severe the impairment to circulation. Early symptoms may include cold feet, purple or red discoloration of the toes, or muscle cramping after walking short distances (intermittent claudication). Later findings may include a sore that won’t heal (ischemic ulcer), pain at night while resting in bed, or tissue death to part of the foot (gangrene).
The diagnosis of ischemia is made by reviewing the patient’s symptoms, examination of the foot, and special testing to evaluate the circulation. The examination should reveal cold skin temperature, and skin atrophy that causes the skin to appear shiny or paper thin with loss of normal hair on tops of the toes and on the lower leg. There is often a color change associated with ischemic feet.
Video: Ischemia






Silent Ischemia: Ischemia with No Pain

Ischemia is a condition in which the blood flow (and thus oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is the name for decreased blood flow and oxygen to the heart muscle.
What is ischemic heart disease? It’s the term given to heart problems caused by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called coronary artery disease and coronary heart disease. This can ultimately lead to heart attack.
Ischemia often causes chest pain or discomfort known as angina pectoris.
What is silent ischemia?
Many Americans may have ischemic episodes without knowing it. These people have ischemia without pain — silent ischemia. They may have a heart attack with no prior warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia.
Having an exercise stress test or wearing a Holter monitor – a battery-operated portable tape recording that measures and records your electrocardiogram (ECG) continuously, usually for 24-48 hours – are two tests often used to diagnose this problem. Other tests also may be used.






What is Myocardial Ischemia?

Myocardial ischemia occurs when blood flow to your heart muscle is decreased by a partial or complete blockage of your heart’s arteries (coronary arteries). The decrease in blood flow reduces your heart’s oxygen supply.
Myocardial ischemia, also called cardiac ischemia, can damage your heart muscle, reducing its ability to pump efficiently. A sudden, severe blockage of a coronary artery may lead to a heart attack. Myocardial ischemia may also cause serious abnormal heart rhythms.
Treatment for myocardial ischemia is directed at improving blood flow to the heart muscle and may include medications, a procedure to open blocked arteries or coronary artery bypass surgery. Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.






Could you have a Heart Attack and not Know it?

Sometimes people have heart attacks and never know it. It’s called the silent heart attack, when someone either shows no symptoms at all or ignores or misinterprets the symptoms until the pain goes away. Because the key to recovering from a heart attack is by restoring the blood flow to the heart as quickly as possible, silent heart attacks are even more deadly. In fact, twice as many people die from the silent type of heart attack as those who experience the typical variety
What’s going on here in most cases is something called ischemia — when blood that normally flows to a part of the body is temporarily restricted. When this happens to the heart it’s called cardiac ischemia. A temporary loss of blood flow to the heart causes chest pain, or angina, which is basically a warning sign that something bad could happen shortly. This is where things get a little tricky. Sometimes there’s no angina. This is called silent ischemia and it leads to the silent heart attack. That’s the trouble with silent ischemia — there are no symptoms.






Medication treatment of myocardial Ischemia

Treatment of myocardial ischemia is directed at improving blood flow to the heart muscle. Depending on the severity of your condition, you may be treated with medications, undergo a surgical procedure or both.
Medications that can be used to treat myocardial ischemia include:
Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner.This can reduce the tendency of your blood to clot.
Nitroglycerin. This medication temporarily opens arterial blood vessels, improving blood flow to and from your heart.
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.
Cholesterol-lowering medications. By decreasing the amount of cholesterol in your blood, especially low-density lipoprotein (LDL), or “bad,” cholesterol, these drugs decrease the primary material that deposits on the coronary arteries.
Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels.
Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels and lower blood pressure.