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Treatments and drugs
By Mayo Clinic staffTreatment 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
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, which may help prevent obstruction of your coronary arteries. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or if you're already taking another blood thinner, so ask your doctor before starting to take aspirin.
- 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. Boosting your high-density lipoprotein (HDL), or "good," cholesterol, may help, too. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
- Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.
- Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels and lower blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including constricting your blood vessels.
- Ranolazine (Ranexa). This medication helps relax your heart arteries. Ranolazine is an anti-angina medication that may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
Procedures to improve blood flow
Sometimes more aggressive treatment is needed to improve blood flow. Surgical procedures that may help include:
- Angioplasty and stenting. During angioplasty — also called a percutaneous coronary intervention (PCI) — your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a tiny, deflated balloon is passed through the catheter to the narrowed area. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. Some stents slowly release medication to help keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating myocardial ischemia.
- Coronary artery bypass surgery. During this procedure, a surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's typically reserved for cases of multiple narrowed coronary arteries.
References
- Deedwanla PC. Silent myocardial ischemia: Prognosis and therapy. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Deedwanla PC. Silent myocardial ischemia: Epidemiology and pathogenesis. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Goldberger AL. Electrocardiogram in the diagnosis of myocardial ischemia and infarction. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Deedwanla PC. Silent myocardial ischemia: Diagnosis and screening. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Cardiac biomarkers. American Association for Clinical Chemistry. http://www.labtestsonline.org/understanding/analytes/cardiac_biomarkers/glance.html. Accessed March 22, 2012.
- Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0398-6..C2009-0-59734-6--TOP&isbn=978-1-4377-0398-6&about=true&uniqId=236798031-10. Accessed March 22, 2012.
- Lanza GA, et al. Mechanisms of coronary artery spasm. Circulation. 2011;124:1774.
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