Have you ever been woken up in the middle of the night by a sudden chest pain? Have you experienced chest tightness and shortness of breath after exertion? These symptoms may be related to an "invisible killer" - myocardial ischemia.
What's going on with myocardial ischemia?
The heart is a powerful pump that pumps oxygen-rich blood to every corner of the body. But don't forget, the heart itself needs oxygen and nutrients. These sources of life are delivered to the heart muscle through the coronary arteries.
Myocardial ischemia, simply put, is a pathological condition in which the muscles of the heart (myocardium) are unable to obtain sufficient oxygen and nutrients due to insufficient blood supply to the coronary arteries, thus affecting their normal function. This is usually caused by coronary atherosclerosis causing the lumen to narrow, blocking blood flow.
Blockage of the coronary arteries
So, what is the culprit of myocardial ischemia? In most cases, coronary arteriosclerosis, or atherosclerosis as it is medically called. This process is like a gradual build-up of limescale on the inner wall of the pipe, narrowing the water flow path. The "scale" of the coronary arteries is actually a plaque made up of fat, cholesterol, calcium, and other substances. Over time, these plaques can rupture and cause blood clots, further reducing or even temporarily blocking the blood supply to the heart muscle.
What are the other causes besides coronary atherosclerosis?
1. Thrombosis: In blood vessels that already have atherosclerosis, ruptured plaque may trigger the formation of blood clots (thrombosis) that can further block the coronary arteries.
2. Coronary artery spasm: Sudden tightening or spasm of the coronary arteries may temporarily reduce or block blood flow.
3. Excessive physical exertion or emotional stress: These factors can increase the heart's need for oxygen, which can lead to myocardial ischemia if the coronary arteries are unable to provide adequate blood flow to meet the increased demand.
4. Anatomical abnormalities: such as the origin of coronary artery abnormalities in congenital heart disease.
5. Inflammation: For example, associated vasculitis can affect the coronary arteries.
6. Changes in blood viscosity: For example, in some blood disorders, blood becomes thicker and has difficulty flowing through tiny blood vessels, including coronary arteries.
7. Microvascular disease: Dysfunction of the heart's microvessels (small vessels) may cause myocardial ischemia even if there is no obvious disease in the major coronary arteries.
8. Other factors: such as smoking, high blood pressure, hyperlipidemia, diabetes, etc., are all risk factors for myocardial ischemia and they contribute to coronary artery disease through different mechanisms.
If left untreated, the condition can progress to myocardial infarction (heart attack) and require immediate medical intervention.
Warning signs of myocardial ischemia
1. Chest pain (angina): This is the most typical symptom and patients usually describe a feeling of pressure, weight, or pain in the center of the chest. The pain can sometimes radiate to the shoulders, arms, neck, jaw and even back.
2. Shortness of breath: Insufficient blood supply to the heart muscle leads to reduced heart function and inability to pump blood effectively to meet the body's needs, resulting in shortness of breath.
3. Fatigue: Patients often feel unusually tired due to reduced heart efficiency.
4. Nausea or vomiting: Myocardial ischemia can affect the function of the digestive system and cause discomfort.
5. Sweating: Cold sweat is another common symptom of a cardiac event, especially when accompanied by chest pain.
6. Syncope or dizziness: Vertigo or a brief loss of consciousness may occur because the heart is unable to pump blood efficiently to the brain.
7. Arrhythmias: Myocardial ischemia can cause the heart to beat too fast, too slow, or irregularly.
8. Feelings of anxiety: Patients may feel intense feelings of uneasiness and fear of what is about to happen.
9. Epigastric discomfort: Some people may experience epigastric discomfort similar to indigestion.
Not all patients with myocardial ischemia will have obvious symptoms. Sometimes, especially in people with diabetes, myocardial ischemia may have a "silent" attack, which is known as "asymptomatic" or "silent" myocardial ischemia.
If you suspect that you or someone else is experiencing symptoms of myocardial ischemia, you should seek emergency medical help immediately.
Golden time: emergency management of myocardial ischemia
1. Stop all activities immediately: If the patient has any symptoms of myocardial ischemia, such as chest pain or difficulty breathing, immediately stop all ongoing activities and sit or lie down.
2. Call emergency medical services: You should call 120 or the nearest emergency number to report symptoms and request immediate help.
3. Use nitroglycerin: If the patient has a prescription for nitroglycerin from a doctor and has previously used it for angina, they can take it as directed (usually by placing the pill under the tongue). If there is still no relief after 5 minutes, you can take it again. If chest pain persists after the third dose, urgent medical attention is required. Be aware that nitroglycerin may cause headaches or lower blood pressure.
4. Aspirin: While waiting for first responders to arrive, if the patient is not allergic to aspirin, has no bleeding tendency, and has not been told that aspirin is not suitable for aspirin, one adult dose of aspirin (usually 300 mg) can be chewed and swallowed, which can reduce blood clotting. However, it is important to follow the instructions of a medical professional.
5. Stay calm: Try to keep the patient calm to avoid further straining the heart.
6. Monitor the patient's status: While waiting for the ambulance to arrive, the patient's consciousness, breathing, and pulse should be continuously monitored, if possible.
7. Prepare for CPR: If the patient is unconscious and not breathing or not breathing normally (e.g., wheezing), cardiopulmonary resuscitation (CPR) should be started immediately and an automated external defibrillator (AED) should be used as needed.
8. Don't leave the patient alone: While waiting for rescue, don't leave the patient alone.
The above steps can provide initial assistance while waiting for professional medical help to arrive, but the most important thing is to get professional medical intervention as soon as possible. Myocardial ischemia is a medical emergency, and early treatment is essential to prevent myocardial infarction and preserve heart function.
How to prevent myocardial ischemia
- Eat a healthy diet: Increase your intake of fruits and vegetables and limit your consumption of saturated and trans fats.
- Exercise regularly: Staying active promotes blood circulation while helping to control weight and blood pressure.
- Quit smoking: Smoking is a major risk factor for coronary artery disease.
- Limit alcohol: Excessive alcohol consumption can increase blood pressure.
- Manage stress: Long-term stress can damage your blood vessels and heart.
- Regular physical examinations: check cholesterol levels and blood pressure, and use medication if necessary.
How to treat myocardial ischemia
- Drug therapy:
- Nitroglycerin: Used for quick relief of chest pain.
- Antiplatelet drugs, such as aspirin or clopidogrel, prevent blood clots.
- β receptor blockers: can reduce heart rate, blood pressure, and reduce the burden on the heart.
- ACE inhibitors: help lower blood pressure and reduce the workload on the heart.
- Calcium channel blockers: dilate the coronary arteries and reduce the burden on the heart.
- Anticoagulant drugs, such as warfarin, are used to reduce the tendency of blood to clot.
- Statins: used to lower cholesterol levels and prevent atherosclerosis.
- Interventional Therapy:
- Coronary angiography: to understand the degree and location of coronary artery narrowing.
- Percutaneous coronary intervention (PCI): Balloon dilation and stent placement are used to open narrowed or blocked arteries.
- Coronary artery bypass graft (CABG): used in severe multivessel or trunk disease to surgically create new blood vessels that bypass blockage.
Myocardial ischemia is like a time bomb lurking in our hearts, but as long as we develop a healthy lifestyle, regular check-ups, timely treatment, and maintain a good attitude, we can effectively prevent and defeat it. Let us guard this source of life with our hearts, so that every heartbeat is full of strength and vitality!