Myocardial Ischemia: Insights from an Exercise ECG Report

Exercise Electrocardiogram Report - Follow-up on Myocardial Ischemia Issues

Dear Dr.
He,
I am Mr.
Wang, with inquiry number #118453.
Thank you for taking the time to address my concerns.
Following up on my previous question, I would like to ask you further.

First, in response to your question regarding my exercise stress test, I did not experience any chest pain or other discomfort during the procedure.
The only issue was that the treadmill speed was too fast during the running phase, which caused my legs to feel extremely fatigued.
The nurse advised me to stop running, which is why I did not complete the entire exercise stress test.
The report indicated that there was evidence of myocardial ischemia.

I would like to inquire about the following:
(1) My cardiologist has prescribed a one-month supply of medication, which includes "Bokey Enteric-Microencapsulated 100mg" (Aspirin) and "Isobide 10mg/Tab" (Isosorbide Dinitrate 10 mg/Tab).
Aside from Nitrostat, which is an emergency medication, do I need to take the other two medications for life, similar to blood pressure medications?
(2) Can factors such as autonomic nervous system dysfunction, anxiety, tension, and panic also lead to myocardial ischemia?
(3) Is myocardial ischemia a reversible condition that can be completely cured?
Thank you for your response.

Mr. Wang, 30~39 year old female. Ask Date: 2017/02/04

Dr. He Dongjin reply Cardiology

Hello, because your exercise electrocardiogram showed a positive response and no one had the foresight to know the condition inside your body before performing angiography, the physician, prioritizing patient safety, will definitely prescribe the aforementioned medications.
Unless you undergo cardiac catheterization or a computed tomography (CT) scan to confirm that the blood vessels are fine, no physician would dare to advise you to stop the medication.
It is recommended to arrange for a CT scan, which is not dangerous.
If there are any lesions, they can be addressed; if not, there is no need to worry about how long to take the medication.
Factors such as autonomic nervous system dysregulation, anxiety, tension, and panic generally do not lead to myocardial ischemia but can easily cause chest pain symptoms.
Myocardial ischemia is generally irreversible unless treated with cardiac catheterization; simply taking medication will not resolve it.
Changhua Hospital cares about you.

Reply Date: 2017/02/04

More Info

Understanding myocardial ischemia is crucial for managing heart health, especially when interpreting results from an exercise ECG report. Myocardial ischemia occurs when blood flow to the heart muscle is reduced, preventing it from receiving enough oxygen. This condition can lead to chest pain (angina) and, if severe or prolonged, can result in a heart attack.

1. Medication Management
Regarding the medications prescribed to you, it’s important to understand their roles:
- Aspirin (Bokey Enteric-Microencapsulated 100mg): This is an antiplatelet medication that helps prevent blood clots, reducing the risk of heart attacks and strokes. It is often recommended for individuals with a history of cardiovascular issues or those at risk.

- Isosorbide Dinitrate (Isobide 10mg): This medication is a nitrate that helps to dilate blood vessels, improving blood flow to the heart and alleviating symptoms of angina. It is typically used on a long-term basis for managing chronic angina.

- Nitroglycerin (Nitrostat): This is a fast-acting medication used to relieve acute angina attacks. It is not intended for daily use but rather for immediate relief when symptoms occur.

In terms of whether you will need to take these medications for life, it largely depends on your individual health status, the severity of your ischemia, and how well your condition responds to treatment. Many patients with coronary artery disease (CAD) or ischemic heart disease may need to continue these medications long-term to manage their condition effectively.

2. Psychological Factors and Myocardial Ischemia
You raised an important point regarding the impact of psychological factors such as anxiety, stress, and panic on heart health. Indeed, these factors can contribute to myocardial ischemia. Stress can lead to increased heart rate and blood pressure, which may exacerbate ischemic conditions. Additionally, anxiety can trigger physical symptoms that mimic angina, leading to further distress. It is essential to manage stress through relaxation techniques, therapy, or lifestyle changes, as these can positively impact heart health.

3. Reversibility of Myocardial Ischemia
Myocardial ischemia can be reversible, especially if it is identified early and managed appropriately. Treatment options may include lifestyle modifications (such as diet and exercise), medications, and in some cases, surgical interventions like angioplasty or bypass surgery. The goal of treatment is to restore adequate blood flow to the heart muscle, thereby alleviating symptoms and preventing further complications.

In your case, since you did not experience chest pain during the exercise ECG but did have symptoms of leg soreness, it suggests that while your heart may be under stress, it is not necessarily in immediate danger. The presence of ischemia indicates that there is a need for ongoing monitoring and management.

Conclusion
In summary, managing myocardial ischemia involves a combination of medication, lifestyle changes, and addressing psychological factors. Regular follow-ups with your cardiologist are essential to monitor your condition and adjust treatment as necessary. If you have concerns about the medications or your symptoms, do not hesitate to discuss them with your healthcare provider. They can provide personalized advice based on your health history and current condition.

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