How To Detect Myocardial Ischemia

Myocardial ischemia can be evaluated through three main categories of diagnostic tests. These include electrocardiography (ECG), myocardial imaging, and assessments of the coronary arteries that supply blood to the heart muscle. Each method plays a crucial role in identifying the presence and severity of ischemia.

1. Electrocardiogram (ECG)

Standard ECG is often the first test performed and records the heart's electrical activity in a resting state. It can detect abnormalities that suggest reduced blood flow to the heart muscle.

24-Hour Ambulatory ECG Monitoring involves wearing a portable ECG device for a full day to capture any episodes of ischemia that may occur during daily activities.

Exercise Stress ECG, also known as a treadmill test, is used to evaluate how the heart responds to physical exertion. Patients walk on a treadmill while their heart activity is monitored, which can help identify ischemia that occurs during increased cardiac demand.

2. Myocardial Imaging Techniques

Echocardiography, or cardiac ultrasound, is commonly used to visualize the heart's structure and function. It can detect reduced movement in the heart walls, which may indicate areas of ischemia.

Nuclear Myocardial Imaging involves injecting a small amount of radioactive tracer to assess blood flow to the heart muscle. This test provides detailed images of perfusion patterns and can highlight regions with inadequate supply.

Cardiac MRI and PET-CT scans are advanced imaging modalities that offer high-resolution images of the heart. These techniques are particularly useful in detecting subtle or complex cases of myocardial ischemia and can provide functional and metabolic insights.

3. Coronary Artery Evaluation

Coronary CT Angiography (CTA) is a non-invasive outpatient procedure that uses contrast dye and CT scanning to visualize the coronary arteries. It helps identify blockages or narrowing that could lead to ischemia.

Invasive Coronary Angiography is typically performed in a hospital setting. A catheter is inserted through the wrist or groin and guided to the coronary arteries, where contrast dye is injected. This allows physicians to get a clear view of any obstructions and determine if they are causing ischemia.