Myocardial Ischemia: Insights on Diagnosis and Treatment Options

Myocardial hypoxia

Dear Dr.
He,
I have some questions to ask.
At the end of September last year, I underwent an exercise electrocardiogram (ECG) which showed a positive response for hypoxia.
The doctor recommended a cardiac catheterization because I occasionally experience chest tightness.
I asked the doctor if we could just observe the situation for now, and he advised that if I feel unwell, I should go to the emergency room immediately.

I obtained the report from the exercise ECG and consulted with a cardiologist at another hospital.
The doctor confirmed the presence of hypoxia and suggested considering a cardiac catheterization since I had just undergone the exercise ECG.
I inquired if there were other tests available, and the doctor scheduled a myocardial perfusion scan for three months later.

I had the scan done at the end of December last year, and during my follow-up appointment yesterday, I reviewed the report.
The doctor indicated that there was evidence of hypoxia and that there was some vascular blockage; however, this test could not determine the percentage of blockage, only that the extent of blockage was not significant.
I asked the doctor if I needed to undergo cardiac catheterization to clear the blockage, and he said it was not necessary for now and that I should continue taking medication to manage my condition.
If I continue to experience frequent chest tightness accompanied by shortness of breath, we could consider the catheterization later.
The medications have remained unchanged, consisting only of Concor (bisoprolol) 1.25 mg and aspirin 100 mg.
Dr.
He, based on the doctor's recommendations and the findings from the myocardial perfusion report, is my condition serious? The doctor mentioned that the extent of the blockage is not significant; does this imply that it is not very severe? I have many concerns and worries due to the limited consultation time, and I would greatly appreciate your help in alleviating my doubts and anxieties.
Additionally, does the doctor's statement that a cardiac catheterization is not currently needed indicate that my condition is not serious at this time?
I apologize for the many questions, and I am very grateful for your answers.
Thank you.

Mr. Wang, 40~49 year old female. Ask Date: 2017/03/02

Dr. He Dongjin reply Cardiology

Hello, myocardial perfusion imaging can determine the severity of hypoxia as mild, moderate, or severe.
Currently, the consensus among experts is that mild cases can be managed with medication, while moderate to severe cases are recommended for catheterization.
The physician's suggestion that catheterization is not necessary indicates that your current condition is not severe, so it is presumed that you are experiencing only mild hypoxia.
If you are still feeling unwell and are very concerned, it is advisable to undergo a computed tomography coronary angiography.
Changhua Hospital cares about your well-being.

Reply Date: 2017/03/02

More Info

Myocardial ischemia is a condition characterized by reduced blood flow to the heart muscle, often due to coronary artery disease (CAD). Understanding the diagnosis and treatment options for myocardial ischemia is crucial for managing your health effectively. Based on your history and the findings from your myocardial perfusion scan, let’s delve into the implications of your condition and the rationale behind your physician's recommendations.

Diagnosis of Myocardial Ischemia
Your previous exercise electrocardiogram (ECG) indicated signs of ischemia, which prompted your doctor to recommend a coronary angiogram. This is a common approach when there are symptoms like chest tightness or discomfort, especially in the context of risk factors such as age, family history, and lifestyle choices. The myocardial perfusion scan you underwent later provided additional insights. It showed areas of reversible perfusion defects, suggesting that there are regions of your heart that are not receiving adequate blood flow under stress conditions, which is indicative of ischemia.

Interpretation of Findings
The results from your myocardial perfusion scan indicated that there is some degree of ischemia, but your doctor noted that the extent of blockage is not significant. This is an important distinction. While ischemia is present, the phrase "not significant" typically means that the blood flow is compromised but not to a level that would necessitate immediate invasive intervention like angioplasty or bypass surgery. The fact that your doctor has recommended continuing with medication (Concor and aspirin) and monitoring your symptoms suggests that they believe your condition can be managed conservatively at this time.

Treatment Options
1. Medication Management: The medications you are currently taking, such as Concor (a beta-blocker) and aspirin, are standard treatments for managing ischemic heart disease. Beta-blockers help reduce the heart's workload and lower blood pressure, while aspirin helps prevent blood clots. It’s crucial to adhere to this regimen and report any changes in symptoms to your physician.

2. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact your heart health. This includes adopting a heart-healthy diet, engaging in regular physical activity (as advised by your doctor), quitting smoking if applicable, and managing stress levels.

3. Monitoring Symptoms: Your doctor’s advice to seek emergency care if you experience worsening symptoms is vital. Chest pain, shortness of breath, or any new symptoms should be taken seriously, as they may indicate a change in your condition.

4. Follow-Up Testing: The decision to delay invasive procedures like coronary angiography is often based on the current assessment of risk versus benefit. If your symptoms remain stable and manageable with medication, your doctor may prefer to monitor your condition through regular follow-ups and possibly additional non-invasive tests.

Conclusion
In summary, while your myocardial perfusion scan indicates the presence of ischemia, the assessment that the blockage is not significant suggests that your condition is currently manageable without immediate invasive intervention. Your physician's recommendations align with standard practice in cardiology, focusing on conservative management and careful monitoring. It is essential to maintain open communication with your healthcare provider, report any new or worsening symptoms, and adhere to the prescribed treatment plan. If you have further concerns or if your symptoms change, do not hesitate to seek a follow-up appointment for a more comprehensive evaluation. Your health and peace of mind are paramount, and addressing these concerns proactively is the best approach.

Similar Q&A

Understanding Myocardial Ischemia: Treatment Options and Next Steps

Hello, doctor! I underwent an exercise electrocardiogram, and my attending physician mentioned myocardial ischemia, recommending either a cardiac catheterization or a CT scan. However, another doctor suggested that it is mild and that medication would suffice, but then referred m...

Dr. He Dongjin reply Cardiology
Hello, based on a Duke Treadmill Score of -3, you are classified as moderate risk. The next steps should depend on your symptoms and any changes in your electrocardiogram (ECG), which I have not seen. Based solely on the report, it indicates moderate risk. If you are asymptomatic...

Understanding Myocardial Ischemia: Insights from ECG and Echocardiogram Results

Hello Doctor, I have noticed significant differences in the test results from a clinic and a large hospital, and I hope you can assist in interpreting them. Thank you! [Clinic A] 1. 24-Hour Holter Monitor: - 402.10 HYPERTENSIVE HEART DISEASE, BENIGN WITHOUT CONGESTIVE...

Dr. He Dongjin reply Cardiology
Hello, I trust large hospitals. I cannot make a judgment without seeing the relevant images, but I believe it is better to observe first. Changhua Hospital cares about you.

Managing Suspected Myocardial Ischemia: Patient Insights and Recommendations

Hello, I am the patient who just asked about angina. It seems that patients with frequent angina attacks cannot undergo nuclear medicine myocardial perfusion imaging. I get short of breath when I exercise and I'm a bit afraid of the exercise stress test. Would it be better f...

Dr. Wu Xueming reply Cardiology
A 24-hour electrocardiogram is not very helpful in assessing myocardial ischemia. Current medications, if they can control symptoms, are recommended to be continued.

Mild Myocardial Ischemia: Understanding Your Heart Health and Management

Hello, Doctor He. I have had high blood pressure since I was 18 years old, and after turning 30, I started taking antihypertensive medication. I am currently 40 years old and take Amlodipine 5/80 daily. In November 2010, during a health check-up, the report indicated that the exe...

Dr. He Dongjin reply Cardiology
Hello, mild myocardial ischemia. It is advisable to follow your attending physician's recommendations to maintain the current status. Blood pressure, dietary control, and exercise are sufficient. Changhua Hospital cares about you.