Treatments and drugsBy Mayo Clinic Staff
Treatment 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, surgery or both.
Medications to treat myocardial ischemia include:
- Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent obstruction of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you're already taking another blood thinner.
- Nitrates. These medications temporarily open arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn't have to work as hard.
- 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.
- Calcium channel blockers. These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.
- Cholesterol-lowering medications. These medications decrease the primary material that deposits on the coronary arteries.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels and lower blood pressure. Your doctor might recommend an ACE inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia.
- Ranolazine (Ranexa). This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.
Procedures to improve blood flow
Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:
July 25, 2015
- Angioplasty and stenting. A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.
- Coronary artery bypass surgery. A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.
- Enhanced external counterpulsation. This noninvasive outpatient treatment might be recommended if other treatments haven't worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart.
- Mann DL, et al. Approach to the patient with chest pain. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2014.
- Podrid PJ. Angina pectoris: Chest pain caused by myocardial ischemia. www.uptodate.com/home. Accessed June 1, 2015.
- Deedwania PC. Silent myocardial ischemia: Epidemiology and pathogenesis. www.uptodate.com/home. Accessed June 1, 2015.
- Mann DL, et al. Coronary blood flow and myocardial ischemia. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2014.
- Kannam JP. Stable ischemic heart disease: Overview of care. www.uptodate.com/home. Accessed June 2, 2015.
- Jhamnani S, et al. Meta-analysis of the effects of lifestyle modifications on coronary and carotid artherosclerotic burden. American Journal of Cardiology. 2015;115:268.
- Sandesara PB, et al. Cardiac rehabilitation and risk reduction: Time to "rebrand and reinvigorate." Journal of the American College of Cardiology. 2015;65:389.
- Goldberger AL. Electrocardiogram in the diagnosis of myocardial ischemia and infarction. www.uptodate.com/home. Accessed June 1, 2015.
- AskMayoExpert. How is chest pain due to coronary artery spasm diagnosed? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
- Johnson RJ. Nonpharmacologic prevention and treatment of hypertension. In: Comprehensive Clinical Nephrology. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. Accessed May 11, 2015.
- Deedwania PC. Silent myocardial ischemia: Prognosis and therapy. www.uptodate.com/home. Accessed June 1, 2015.
- Deedwania PC. Silent myocardial ischemia: Diagnosis. www.uptodate.com/home. Accessed June 1, 2015.
- AskMayoExpert. Which patients with coronary artery disease (CAD) should be considered for angiography and revascularization? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Bope ET, et al. The cardiovascular system. In: Conn's Current Therapy 2015. Philadelphia, Pa.: Saunders Elsevier; 2015.
- Simons M, et al. New therapies for angina pectoris. www.uptodate.com/home. Accessed July 6, 2015.