Myocardial ischemia occurs when blood flow to your heart is reduced, preventing it from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart's arteries (coronary arteries).

Myocardial ischemia, also called cardiac ischemia, can damage your heart muscle, reducing its ability to pump efficiently. A sudden, severe blockage of a coronary artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms.

Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries or bypass surgery.

Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.


Some people who have ischemia don't experience any signs or symptoms (silent ischemia).

When signs and symptoms occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include:

  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath when you are physically active
  • Nausea and vomiting
  • Sweating
  • Fatigue

When to see a doctor

Seek emergency care if you have prolonged or severe chest pain.


Myocardial ischemia occurs when the blood flow through one or more of your coronary arteries is decreased. The low blood flow decreases the amount of oxygen your heart muscle receives.

Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can occur quickly when an artery becomes blocked suddenly.

Conditions that can cause myocardial ischemia include:

  • Coronary artery disease (atherosclerosis). Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia.
  • Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body.
  • Coronary artery spasm. This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia.

Chest pain associated with myocardial ischemia can be triggered by:

  • Physical exertion
  • Emotional stress
  • Cold temperatures
  • Cocaine use

Risk factors

Factors that can increase your risk of developing myocardial ischemia include:

  • Tobacco. Smoking and long-term exposure to secondhand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking also increases the risk of blood clots in your coronary arteries.
  • Diabetes. Type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.
  • High blood pressure. Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries.
  • High blood cholesterol level. Cholesterol is a major part of the deposits that can narrow your coronary arteries. A high level of "bad" (low-density lipoprotein, or LDL) cholesterol in your blood may be due to an inherited condition or a diet high in saturated fats and cholesterol.
  • High blood triglyceride level. Triglycerides, another type of blood fat, may also contribute to atherosclerosis.
  • Obesity. Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels.
  • Waist circumference. A waist measurement of more than 35 inches (89 centimeters) for women and 40 inches (102 cm) in men increases the risk of high blood pressure and heart disease.
  • Lack of physical activity. An inactive lifestyle contributes to obesity and is associated with higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better cardiovascular fitness, which is associated with a decreased risk of myocardial ischemia and heart attack. Exercise also lowers high blood pressure.


Myocardial ischemia can lead to serious complications, including:

  • Heart attack. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.
  • Irregular heart rhythm (arrhythmia). An abnormal heart rhythm can weaken your heart and may be life-threatening.
  • Heart failure. Myocardial ischemia can damage the heart muscle, reducing its ability to effectively pump blood to the rest of your body. Over time, this damage might lead to heart failure.


The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.

March 09, 2018
  1. 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.
  2. Podrid PJ. Angina pectoris: Chest pain caused by myocardial ischemia. www.uptodate.com/home. Accessed June 1, 2015.
  3. Deedwania PC. Silent myocardial ischemia: Epidemiology and pathogenesis. www.uptodate.com/home. Accessed June 1, 2015.
  4. 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.
  5. Kannam JP. Stable ischemic heart disease: Overview of care. www.uptodate.com/home. Accessed June 2, 2015.
  6. 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.
  7. Sandesara PB, et al. Cardiac rehabilitation and risk reduction: Time to "rebrand and reinvigorate." Journal of the American College of Cardiology. 2015;65:389.
  8. Goldberger AL. Electrocardiogram in the diagnosis of myocardial ischemia and infarction. www.uptodate.com/home. Accessed June 1, 2015.
  9. AskMayoExpert. How is chest pain due to coronary artery spasm diagnosed? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  10. 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.
  11. Deedwania PC. Silent myocardial ischemia: Prognosis and therapy. www.uptodate.com/home. Accessed June 1, 2015.
  12. Deedwania PC. Silent myocardial ischemia: Diagnosis. www.uptodate.com/home. Accessed June 1, 2015.
  13. 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.
  14. Bope ET, et al. The cardiovascular system. In: Conn's Current Therapy 2015. Philadelphia, Pa.: Saunders Elsevier; 2015.
  15. Simons M, et al. New therapies for angina pectoris. www.uptodate.com/home. Accessed July 6, 2015.