Cardiac ischemia is a lack of blood flow in the vessels that supply blood to the heart muscle--the coronary arteries. Transient, or brief, ischemia involves spasmodic attacks of intense pain; doctors often refer to this as angina. If the ischemia is prolonged and heart muscle tissue dies, a myocardial infarction, or heart attack, occurs.
Classification of Symptoms
Symptoms of cardiac ischemia can be classified as typical and atypical, and it is helpful for a doctor to know the duration of those symptoms to aid in his diagnosis. Symptoms that last briefly--say, a few minutes to less than an hour--are more often associated with angina. If the symptoms do not readily resolve with rest and continue for hours, even if intermittently, it is suggestive of a myocardial infarction. These symptoms can occur with non-cardiac conditions as well.
Typical symptoms
Chest pain, especially pain that develops during physical exertion, such as running or during sex, but that resolves with rest, suggests ischemia. Chest pain can vary in its location and intensity. Some patients describe the experience as a tightening in the middle of the chest or severe pressure. It may be localized over the upper left chest, it may also radiate to the back or it can mimic heartburn. Simply pressing on that area of the chest cannot reproduce the same pain.
Accompanying symptoms include diaphoresis (sweaty palms, clammy skin), nausea and vomiting or shortness of breath (dyspnea). Pain radiating to the jaw or down the left arm, heart palpitations and dizziness are also symptoms of ischemia.
Respiratory issues, gastrointestinal conditions, anxiety and musculoskeletal problems in the muscles overlying the chest or between the ribs can cause similar complaints.
Atypical symptoms
Atypical symptoms are seen in women, diabetics and the elderly more frequently than other demographics. Atypical symptoms may include abdominal pain, heartburn, anxiety or simply fatigue. Ischemia also can occur without any noticeable symptoms, a condition known as silent ischemia.
