Materiały źródłowe

• #1 Myocardial ischemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/symptoms-causes/syc-20375417

  Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle 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 occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). […] Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty) or bypass surgery. […] 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.

• #2 Myocardial Ischemia – Nuclear Medicine and Risk Stratification: Practice Essentials, Determining the Pretest Probability of Myocardial Ischemia, Indications for Gated Myocardial Perfusion Single-Photon Emission CT

  https://emedicine.medscape.com/article/352401-overview

  Myocardial ischemia is a disorder that is usually caused by a critical coronary artery obstruction, which is also known as atherosclerotic coronary artery disease (CAD). Diagnosing myocardial ischemia prior to a heart attack is important. For approximately one third of patients, CAD is not diagnosed until after a heart attack occurs. […] The diagnosis of CAD can be difficult to make. Frequently, the disease is diagnosed only after the patient has had a heart attack. The symptoms of CAD range from unstable angina to no symptoms at all. […] Several studies have been designed to help the clinician determine a patients CAD risk level. With this information, the clinician can decide, with reasonable certainty, which type of workup is indicated. […] The nuclear myocardial scan is the best initial imaging study for the detection of myocardial ischemia; however, in some locales, stress echocardiography is performed more often because it is more readily available and because local clinicians are better trained in echocardiography and are more comfortable with the technology.

• #3 Tests and diagnosis of Ischaemic Heart Disease | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/ischemic-heart-disease/tests-and-diagnosis

  Medical history. The first step in diagnosing Ischaemic Heart Disease derives from an interview with your doctor. Your doctor will first evaluate the presence of any cardiovascular risk factors: family history, whether you smoke, the presence of diseases associated with ischaemic cardiomyopathy, such as diabetes, high blood pressure or hypercholesterolemia. […] The combined information taken from both sections of the interview is used to determine whether the patient has Ischaemic Heart Disease and to select the most suitable tests to confirm the diagnosis. […] Electrocardiograms also reveal any scar tissue from previous infarctions or the presence of an arrhythmia. […] A heart attack causes certain proteins (troponins) to be released from the heart and into the blood stream. […] Chest X-rays help estimate the size of the heart and the great vessels, as well as the condition of the lungs.

• #4 Silent Myocardial Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK536915/

  Silent myocardial ischemia is a condition of reduced oxygen-rich blood flow to the heart that occurs without chest discomfort or other symptoms of ischemic heart disease, such as dyspnea, nausea, and diaphoresis. However, diagnostic studies are often abnormal. ST-segment changes may be evident on electrocardiography. Echocardiography may show regional wall motion abnormalities. Scintigraphy may reveal perfusion defects. […] The diagnosis requires objective evidence of ischemia, which can be one of the following: ECG changes diagnostic of ischemia during ambulatory monitoring or stress testing, segmental wall motion abnormalities on exercise or dobutamine stress echocardiogram, or resting perfusion defects on nuclear scintigraphy. […] A 1-mm downsloping or horizontal ST depression is suggestive of myocardial ischemia in patients with previously normal ECG. Cardiac biomarkers like troponin-I and ambulatory ECG monitoring help detect postoperative myocardial infarction. These modalities may also help screen older individuals and patients with DM presenting to the hospital for unrelated complaints but are at risk of CAD. Radionuclide imaging is instrumental in detecting ischemia in asymptomatic individuals.

• #5 Heart Attack: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction

  Healthcare providers usually diagnose heart attacks in an emergency room setting. If you have heart attack symptoms, you should undergo a physical examination. A provider will check your pulse, blood oxygen levels and blood pressure, and listen to your heart and lung sounds. Theyll also ask about the symptoms you experienced. They might ask someone who was with you to describe what happened. […] A healthcare provider will diagnose a heart attack using the following: […] One of the most reliable ways to diagnose a heart attack is to check for cardiac troponin in your blood. During a heart attack, the damage to heart muscle cells always causes this chemical marker to appear in your bloodstream. […] This is one of the first tests you get when you come to an ER with heart attack symptoms. Your hearts electrical signals can help tell if an injury is occurring, as well as if there are any rhythm abnormalities.

• #6 Myocardial ischemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/diagnosis-treatment/drc-20375422

  Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend: […] Electrocardiogram (ECG). Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage. […] Stress test. Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise. […] Echocardiogram. Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.

• #7

  https://www.nhs.uk/conditions/heart-attack/diagnosis/

  If a heart attack is suspected, you should be admitted to hospital immediately. You will usually be admitted to an acute cardiac care unit (ACCU), or directly to the cardiac catheterisation unit, to confirm the diagnosis and begin treatment. […] An electrocardiogram (ECG) is an important test in suspected heart attacks. It should be done within 10 minutes of being admitted to hospital. […] An ECG is important because: it helps confirm the diagnosis of a heart attack; it helps determine what type of heart attack you have had, which will help determine the most effective treatment. […] If doctors suspect you have had a heart attack, a sample of your blood will be taken so it can be tested for these heart proteins (known as cardiac markers). […] The most common protein measurement is called cardiac troponin. Your troponin level can help in diagnosing the type of heart attack you’ve had.

• #8 Myocardial Ischaemia • LITFL • ECG Library Diagnosis

  https://litfl.com/myocardial-ischaemia-ecg-library/

  Non-ST-elevation acute coronary syndrome (NSTEACS) encompasses two main entities: Non-ST-elevation myocardial infarction (NSTEMI) and Unstable angina pectoris (UAP). […] The differentiation between these two conditions is usually retrospective, based on the presence/absence of raised cardiac enzymes at 8-12 hours after the onset of chest pain. […] Both produce the same spectrum of ECG changes and symptoms and are managed identically in the Emergency Department. […] While there are numerous conditions that may simulate myocardial ischaemia (e.g. left ventricular hypertrophy, digoxin effect), dynamic ST segment and T wave changes (i.e. different from baseline ECG or changing over time) are strongly suggestive of myocardial ischaemia. […] Horizontal or downsloping ST depression 0.5 mm at the J-point in 2 contiguous leads indicates myocardial ischaemia (according to the 2007 Task Force Criteria).

• #9 Myocardial Ischaemia • LITFL • ECG Library Diagnosis

  https://litfl.com/myocardial-ischaemia-ecg-library/

  ST depression 2 mm in 3 leads is associated with a high probability of NSTEMI and predicts significant mortality (35% mortality at 30 days). […] T wave inversion may be considered to be evidence of myocardial ischaemia if at least 1 mm deep, present in 2 continuous leads that have dominant R waves (R/S ratio 1), and dynamic not present on old ECG or changing over time. […] Wellens syndrome is a pattern of inverted or biphasic T waves in V2-4 (in patients presenting with ischaemic chest pain) that is highly specific for critical stenosis of the left anterior descending artery. […] This pattern is known as Type A Wellens Syndrome and is highly specific for a critical stenosis of the proximal LAD artery. […] There are inverted U waves, most prominent in leads V5-6. This is an infrequently recognised but very specific sign of myocardial ischaemia this patient had a 12-hour troponin of 4.0 ng/mL.

• #10 Diagnosis of myocardial infarction – Wikipedia

  https://en.wikipedia.org/wiki/Diagnosis_of_myocardial_infarction

  A normal ECG does not rule out acute myocardial infarction. […] It should be determined if a person is at high risk for myocardial infarction before conducting imaging tests to make a diagnosis. […] The diagnosis of myocardial infarction requires two out of three components (history, ECG, and enzymes). […] In difficult cases or in situations where intervention to restore blood flow is appropriate, coronary angiography can be performed. […] Histopathological examination of the heart may reveal infarction at autopsy.

• #11 Silent Myocardial Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK536915/

  The following combination of tests is used to detect silent myocardial ischemia. Bedside ECG monitoring is used for continuous cardiac electrical activity assessment and detection of ischemic changes. Cardiac markers measure the levels of enzymes or proteins released into the bloodstream during myocardial injury. Ambulatory ECG monitoring tracks cardiac activity during daily activities, providing valuable information on silent myocardial ischemia episodes. Exercise stress testing evaluates cardiovascular response to physical exertion to detect exercise-induced ischemic changes. Radionuclide imaging techniques provide functional assessment of myocardial perfusion to identify ischemic regions. Continuous intracardiac monitoring offers real-time assessment of cardiac function and ischemic events, which is particularly useful in high-risk patients. Computed tomography provides detailed anatomical imaging of the coronary arteries and myocardial structure.

• #12 Silent Myocardial Ischemia: Diagnosis, Treatment, and Prognosis

  https://www.patientcareonline.com/view/silent-myocardial-ischemia-diagnosis-treatment-and-prognosis

  Ambulatory monitoring. This study is recommended to confirm or refute the presence of SMI in patients with a positive exercise test result.22 For initial diagnosis, however, reserve ambulatory monitoring for patients with ischemia following an acute coronary event and for patients with chronic stable angina who exhibit exercise-inducible ischemia.

• #13 Diagnosis of Stable Ischemic Heart Disease: Recommendations from the ACP | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1001/p469.html

  The American College of Physicians (ACP), in collaboration with the American College of Cardiology Foundation, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons, has developed a guideline that helps physicians diagnose known or suspected cases of stable ischemic heart disease (IHD). Recommendations address IHD and related issues, including initial diagnosis, cardiac stress testing, and coronary angiography. […] Patients with chest pain should undergo a thorough history and physical examination to determine the probability of IHD before undergoing additional testing. […] In patients with an intermediate pretest probability of IHD who have interpretable ECG results and at least moderate physical functioning or no disabling comorbidity, standard exercise ECG is recommended for initial diagnosis.

• #14 Diagnosis of Stable Ischemic Heart Disease: Recommendations from the ACP | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1001/p469.html

  Pharmacologic stress testing with radionuclide myocardial perfusion imaging or echocardiography is recommended in patients with an intermediate to high pretest probability of IHD who are incapable of at least moderate physical functioning or who have a disabling comorbidity. […] Assessing resting left ventricular systolic and diastolic function and evaluating for abnormalities of myocardium, pericardium, or heart valves using Doppler echocardiography are recommended in patients who have known or suspected IHD and previous myocardial infarction, pathologic Q waves, signs or symptoms that suggest heart failure, complex ventricular arrhythmias, or an undiagnosed heart murmur. […] Standard exercise ECG testing for risk assessment is recommended in patients with known stable IHD who are able to exercise and have ECG results that can be interpreted during exercise.

• #15 Diagnosis of Myocardial Ischemia | Radiology Key

  https://radiologykey.com/diagnosis-of-myocardial-ischemia/

  Diagnosis of Myocardial Ischemia […] Although echocardiographic diagnosis of coronary artery stenosis is not a daily practice, it can be clinically valuable for assessing proximal vessel disease when coronary angiography is not practical (i.e., during emergent cardiac surgery) (4,10). […] Segmental endocardial motion and myocardial thickening are the foundations for echocardiographic detection of myocardial ischemia. […] The progression in wall dysfunction from hypokinesia to dyskinesia correlates to the progression in degree of perfusion abnormalities which has been established in dog studies. […] An echocardiographic dog study has found that segmental contraction abnormalities are induced only when myocardial perfusion is less than 25% of control (14). […] Although human data on the possible quantitative relationship between myocardial perfusion and segmental wall contraction are missing, from a clinical point of view acute changes in segmental function are highly indicative of acute ischemia.

• #16 Myocardial ischemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/diagnosis-treatment/drc-20375422

  Stress echocardiogram. A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor’s office on a treadmill or stationary bike. […] Nuclear stress test. Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs allowing blood-flow problems to be identified. […] Coronary angiography. A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye’s path. This test gives your doctor a detailed look at the inside of your blood vessels. […] Cardiac CT scan. This test can determine if you have a buildup of calcium in your coronary arteries a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

• #17 Diagnosis of Myocardial Ischemia | Radiology Key

  https://radiologykey.com/diagnosis-of-myocardial-ischemia/

  The echocardiographer must be cognizant of the various presentations of ischemic tissue, including myocardial stunning and hibernation, which complicate the echocardiographic assessment of myocardial viability. […] Dobutamine stress echocardiography is used for the detection of viable hibernating myocardium. […] A key message is that an RWCA is not always caused by acute ischemia but may reflect stunning, hibernation, and/or nonviable infarcted tissue. […] The 17-segment model of LV topographical anatomy (30) provides a common nomenclature across imaging specialties to define the LV segmental anatomy. […] To grade the severity of ischemia, it is important to analyze both systolic myocardial thickening and endocardial inward motion (radial shortening) (Table 4.2).

• #18

  https://clarity-medical.com/blogs/updates/quick-guide-to-myocardial-ischemia-symptoms-diagnosis-treatment

  Stress Testing: Stress testing, such as exercise treadmill testing (TMT) or pharmacological stress testing, is performed to evaluate the heart’s response to physical exertion or pharmacological stress. Exercise-induced changes in ECG patterns or symptoms suggestive of myocardial ischemia during stress testing may indicate coronary artery disease. […] Coronary Angiography: Coronary angiography is an invasive procedure that involves injecting contrast dye into the coronary arteries to visualize any blockages or narrowing of the arteries. It is considered the gold standard for diagnosing coronary artery disease and myocardial ischemia. […] Clarity Medical’s TMT (Treadmill Test) machines are instrumental in the accurate diagnosis of myocardial ischemia and other cardiovascular conditions. Key features and benefits of Clarity Medical’s TMT machines include:

• #19 Heart Attack: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction

  Using ultrasound (high-frequency sound waves), an echocardiogram generates a picture of the inside and outside of your heart. It can show how well your heart is squeezing and how well the valves are working. […] This is a procedure that uses X-rays and contrast dye to show the blood vessels to your heart and can help determine if there are any blockages. […] This creates a highly detailed scan of your heart and its blood vessels to show if theres any significant narrowing or hardening of the major coronary arteries. […] This test uses a powerful magnetic field and computer processing to create an image of your heart. It can show problems with the blood flow in the arteries to your heart. […] This test can use an ECG, echocardiogram or nuclear scans while youre physically active to help show if your heart is receiving enough blood flow.

• #20 Silent Myocardial Ischemia: From Pathophysiology to Diagnosis and Treatment

  https://www.mdpi.com/2227-9059/12/2/259

  While screening and diagnosing SMI might seem attractive, the latest European Society of Cardiology (ESC) guidelines on chronic coronary syndromes advise against the use of functional imaging in the general population of asymptomatic subjects, providing only a weak recommendation for those at the highest risk. […] An exercise treadmill test (ETT), also known as a stress test or treadmill stress test, is a diagnostic procedure performed to assess the cardiovascular system’s response to physical exertion. […] Echocardiography plays a crucial role in the assessment of SMI as it provides valuable information about cardiac structure and function, helping clinicians identify areas of compromised blood flow and potential ischemic damage. […] Cardiac magnetic resonance imaging (MRI) stands as a powerful non-invasive imaging modality for the detection and characterization of SMI.

• #21 Silent Myocardial Ischemia: From Pathophysiology to Diagnosis and Treatment

  https://www.mdpi.com/2227-9059/12/2/259

  SPECT is a non-invasive nuclear imaging technique widely employed in the field of cardiology for the detection of silent myocardial ischemia. […] Positron emission tomography (PET) is a sophisticated nuclear imaging modality utilized in cardiology that offers superior spatial resolution and quantitative capabilities, making it a valuable tool in the assessment of myocardial perfusion and metabolism. […] The identification of SMI might have therapeutic implications. […] According to the latest guidelines by the ESC, myocardial revascularization in the setting of SMI is indicated to improve prognosis in left main disease with stenosis >50%, proximal LAD stenosis >50%, two- or three-vessel disease with stenosis >50% and left ventricular ejection fraction ≤35%. […] Silent myocardial ischemia represents a challenging entity in everyday clinical practice due to its asymptomatic nature.

• #22 Myocardial ischemia testing with computed tomography: emerging strategies – Rajiah – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/16793/17296

  CTP has been validated in multiple trials against SPECT, PET, MRI and ICA. […] Against the invasive FFR gold standard, a small study of 42 patients in a 320-slice scanner showed that CTP has 84% specificity and 82% PPV on a per-vessel basis in the diagnosis of lesion specific ischemia. […] The combination 50% stenosis on CTA and perfusion defect on CTP is 98% specific for ischemia, while stenosis 50% and normal perfusion on CTP is 100% specific for excluding ischemia. […] CT-FFR is a non-invasive technique of estimating FFR across a coronary stenosis using anatomic data from cardiac CT without any protocol change or additional contrast/radiation. […] Several studies have been performed using CT-FFR with good accuracy. […] The improved specificity of CT-FFR beyond CTA results in conversion of false-positives to true-negatives in the intermediate risk group in CTA, which significantly decreases the rate of non-obstructive disease in ICA, thus improving the capabilities of CT as a gatekeeper for ICA, and selecting optimal patients for revascularization.

• #23 AI-enabled diagnosis and localization of myocardial ischemia and coronary artery stenosis from magnetocardiographic recordings | Scientific Reports

  https://www.nature.com/articles/s41598-025-90615-x

  Early diagnosis and localization of myocardial ischemia (MS) and coronary artery stenosis (CAS) play a crucial role in the effective prevention and management of ischemic heart disease (IHD). […] This study presents a multi-center, AI-enabled diagnosis and localization of myocardial ischemia and coronary artery stenosis from MCG data. […] The proposed approach achieved an accuracy of 84.7%, a sensitivity of 83.8%, and a specificity of 85.6% in diagnosing IHD, an average accuracy of 78.4% in localization of five MS regions, and an average accuracy of 65.3% in localization of stenosis in three coronary arteries. […] The proposed approach can be used as a fast and accurate diagnosis tool, boosting the integration of MCG examination into clinical routine. […] Both electrocardiograph (ECG) and Magnetocardiography (MCG) as functional examinations have been used for early diagnosis of pre-symptomatic IHD.

• #24 Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms – The Cardiovascular

  https://ecgwaves.com/topic/diagnostic-criteria-acute-myocardial-infarction-troponins-ecg-symptoms/

  Cardiac troponin (T or I) has almost 100% specificity for myocardial cells and is the preferred biomarker according to North American (ACC, AHA) and European (ESC) guidelines. […] A diagnosis of myocardial infarction requires at least two troponin samples. […] Troponin levels increase within 2 to 3 hours after the onset of myocardial necrosis. […] A negative (i.e normal) troponin 6 hours after the last episode of symptoms rules out myocardial infarction. […] Myocardial infarction manifests as pathological Q-waves, reduced R-wave amplitude or fragmented QRS complexes. […] Current guidelines include ECG criteria for ST deviation, T-wave inversion, Q-waves, and R-waves. […] ECG criteria for ischemia/infarction must always be evident in at least two anatomically contiguous (i.e neighboring) leads.

• #25 State-of-the-art diagnosis of myocardial infarction

  https://www.degruyter.com/document/doi/10.1515/dx-2016-0024/html?lang=en

  The current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. […] Knowledge of the universal definition of MI and current guidelines for treatment of acute coronary syndrome allows clinicians to correctly diagnose or rule out MI.

• #26 What Biomarkers Are Useful for Detection of Myocardial Ischemia?

  https://www.acc.org/Latest-in-Cardiology/Articles/2014/07/18/14/24/What-Biomarkers-Are-Useful-for-Detection-of-Myocardial-Ischemia

  However, recent studies have demonstrated that hsTn concentrations may be elevated in the absence of documented scarring on magnetic resonance imaging, may change during exercise testing or may elevate following high heart rates induced with transvenous pacing in those without coronary artery disease; therefore, it is mechanistically reasonable to consider that hsTn may, in certain cases, reflect myocardial ischemia without irreversible cardiac injury. […] It is hypothesized that deranged metabolic milieu present in ischemic organs leads to free radical modification of serum albumin as it passes through the oxygen-starved tissues, affecting its ability to bind cobalt at its amino-terminus. […] These modifications generate measurable amounts of ischemia modified albumin (IMA). […] In pre-clinical studies a very rapid rise of IMA following induced myocardial ischemia was noted, and subsequent clinical studies in patients with chest discomfort a low IMA result appeared particularly promising for the confident exclusion of myocardial ischemia when combined with a normal cTn and 12-lead electrocardiogram.

• #27 What Biomarkers Are Useful for Detection of Myocardial Ischemia?

  https://www.acc.org/Latest-in-Cardiology/Articles/2014/07/18/14/24/What-Biomarkers-Are-Useful-for-Detection-of-Myocardial-Ischemia

  B-type natriuretic peptide (BNP) and its amino-terminal pro-peptide equivalent (NT-proBNP) are important cardiac biomarkers widely-used for detection of heart failure (HF), and are well-established prognostic markers in ACS. […] Importantly, myocardial ischemia may also lead to an increased in ventricular wall stress resulting in release of BNP or NT-proBNP, as demonstrated in studies of exercise tolerance testing, although the extent of change was small. […] Thus, off-label use of the natriuretic peptides as a diagnostic tool for ACS is also reasonable to consider. […] Whole blood choline concentrations have potential promise for the diagnostic evaluation of patients with myocardial ischemia. […] Concentrations of whole blood choline rise in patients with myocardial ischemia, even in settings where no detectable necrosis is present; the origin of choline generation resulting from myocardial ischemia is unclear, but a metabolic alteration within myocytes (from aerobic to anaerobic metabolism) is suspected.

• #28 What Biomarkers Are Useful for Detection of Myocardial Ischemia?

  https://www.acc.org/Latest-in-Cardiology/Articles/2014/07/18/14/24/What-Biomarkers-Are-Useful-for-Detection-of-Myocardial-Ischemia

  Blood plasma contains approximately 40 different forms of unesterified free fatty acid (FFAu) chains, and elevated FFAu have been associated with the presence of myocardial ischemia. […] The mechanism of FFAu release in the context of coronary ischemia is not yet understood; it is hypothesized that ischemia results in increased adipose lipolysis or acute changes in myocardial metabolism. […] To date, no biomarker has been shown to conclusively increase with ischemia alone. […] Of those that have been evaluated, hsTn and FFAu appear the most promising. […] Further studies will be necessary to better determine their utility in the assessment of the potential ACS patient.

• #29 Silent Myocardial Ischemia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29024

  Silent myocardial ischemia refers to a condition where myocardial blood flow is reduced without causing noticeable symptoms like chest pain or discomfort. This disorder is the most common clinical presentation of coronary artery disease (CAD). […] The diagnosis requires objective evidence of ischemia, which can be one of the following: ECG changes diagnostic of ischemia during ambulatory monitoring or stress testing, segmental wall motion abnormalities on exercise or dobutamine stress echocardiogram, or resting perfusion defects on nuclear scintigraphy. […] Silent myocardial ischemia typically arises due to coronary arterial obstruction, hindering adequate blood flow to the myocardium without producing noticeable symptoms. Understanding the intricate relationship between the anatomy of the heart and coronary arteries and myocardial function is crucial in evaluating and determining treatment strategies for patients with silent myocardial ischemia.

• #30 AI-enabled diagnosis and localization of myocardial ischemia and coronary artery stenosis from magnetocardiographic recordings | Scientific Reports

  https://www.nature.com/articles/s41598-025-90615-x

  In this study, we aim to present, a large-scale, multi-center, retrospective cohort study evaluating the performance of an AI-enabled method for IHD diagnosis and localization of obstructed coronary arteries and cardiac ischemic regions from MCG data. […] The proposed method is developed on the 2,158 MCG recordings using a stratified 5-fold cross-validation strategy. […] The IHD diagnostic performance of the proposed approach is presented in Table 2. […] The method showed better performance in recognizing ischemia in the SW region, with an accuracy of 83.3%, a sensitivity of 66.7%, and a specificity of 88.9%. […] Beyond IHD diagnosis, the proposed model can also identify ischemia regions and narrowed coronary arteries from input MCG data, which are important for stratified treatment strategy.

• #31 Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations | Nature Medicine

  https://www.nature.com/articles/s41591-023-02325-4

  Although guidelines recommend fixed cardiac troponin thresholds for the diagnosis of myocardial infarction, troponin concentrations are influenced by age, sex, comorbidities and time from symptom onset. […] To improve diagnosis, we developed machine learning models that integrate cardiac troponin concentrations at presentation or on serial testing with clinical features and compute the Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS) score (0-100) that corresponds to an individual’s probability of myocardial infarction. […] CoDE-ACS had excellent discrimination for myocardial infarction (area under curve, 0.953; 95% confidence interval, 0.947-0.958), performed well across subgroups and identified more patients at presentation as low probability of having myocardial infarction than fixed cardiac troponin thresholds (61 versus 27%) with a similar negative predictive value and fewer as high probability of having myocardial infarction (10 versus 16%) with a greater positive predictive value.

• #32 Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations | Nature Medicine

  https://www.nature.com/articles/s41591-023-02325-4

  Discrimination of the CoDE-ACS models was excellent, with an area under curve of 0.953 (95% CI, 0.947-0.958) at presentation and 0.966 (95% CI, 0.961-0.970) on serial testing. […] CoDE-ACS identified twice as many patients as low probability of myocardial infarction at presentation with a similar negative predictive value and fewer patients as high probability with an improved positive predictive value. […] The CoDE-ACS clinical decision support system could reduce time spent in emergency departments, prevent unnecessary hospital admissions in patients unlikely to have myocardial infarction and at low risk of cardiac death, and improve the recognition and treatment of those with myocardial infarction rather than myocardial injury, with benefits for both patients and health care providers.

• #33 Myocardial ischemia testing with computed tomography: emerging strategies – Rajiah – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/16793/html

  Although cardiac computed tomography (CT) has high negative predictive value to exclude obstructive coronary artery disease (CAD), particularly in the low to intermediate risk population, it has low specificity in the diagnosis of ischemia-inducing lesions. […] Recent advances in CT technology have resulted in the development of multiple techniques to provide hemodynamic information and detect lesion-specific ischemia, namely CT perfusion (CTP), CT-derived fractional flow reserve (CT-FFR) and coronary transluminal attenuation gradient (TAG). […] In this article, we provide a perspective on these emerging CT techniques in the evaluation of myocardial ischemia. […] Accurate functional information is provided by invasive FFR during the ICA, and FFR-guided revascularization has shown improved outcomes and lower cost compared to angiographic stenosis-guided revascularization.

• #34 Myocardial ischemia testing with computed tomography: emerging strategies – Rajiah – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/16793/html

  CT evaluation of myocardial ischemia is now possible with state-of-the-art functional techniques such as CTP, CT-FFR and TAG. […] Combination of CTA and functional CT provides high negative predictive value as well as high specificity, which enables the accurate detection of ischemia-inducing lesions in patients with intermediate stenosis, and hence select appropriate patients for invasive angiography and revascularization.

• #35 Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

  https://www.mdpi.com/2077-0383/11/3/477

  The novelty introduced by the 2019 ESC Guidelines on Chronic Coronary Syndromes in terms of CAD detection was to assign the same level of recommendation to non-invasive diagnostic techniques. On one hand, cCTA has the aim of displaying the presence and entity of coronary atherosclerosis; on the other, stress techniques are intended to show the consequence of obstructive atherosclerotic burden detecting the presence of inducible ischaemia. […] According to availability, centre expertise, and patient characteristics, recommended functional non-invasive tests for the diagnosis of obstructive CAD are the techniques able to detect myocardial ischaemia through stress perfusion abnormalities or stress wall motion abnormalities. […] Stress echocardiography (SE) is one of the second-line stress tests used for the assessment of patients presenting with chest pain and intermediate pre-test likelihood of obstructive CAD. […] In order to overcome such limitations, new approaches with the addition of parameters with different pathophysiological targets have been proposed.

• #36 Type-1 MI (OMI & NOMI) and related complications – EMCrit Project

  https://emcrit.org/ibcc/mi/

  These categorization schemes are useful, but not perfect. For example, as coronary artery thrombosis propagates and then recedes over time, patients may transition between OMI and NOMI patterns. […] Ultimately, patient management should be based on a thoughtful assessment of all clinical data. […] Focal wall-motion abnormalities support the diagnosis of MI. A complete study (e.g., formal echocardiography with contrast) has excellent sensitivity for occlusive myocardial infarction. However, the presence of wall-motion abnormalities has a low specificity (since this may reflect a remote myocardial infarction, myocarditis, or Takotsubo cardiomyopathy). […] Combining echocardiography with ECG can improve specificity. […] Echocardiography allows for hemodynamic assessment of patient and risk stratification.

• #37 Type-1 MI (OMI & NOMI) and related complications – EMCrit Project

  https://emcrit.org/ibcc/mi/

  The differential diagnosis of chest discomfort is broad. The following entities are most notable, especially among critically ill patients. […] The usual components of diagnosis include clinical history, ECGs, echocardiography, troponin level, and potassium level. […] The diagnosis of MI is critical for appropriate management and treatment strategies.

• #38 Myocardial Infarction Differential Diagnoses

  https://emedicine.medscape.com/article/155919-differential

  Epigastric or chest symptoms from myocardial ischemia may incorrectly be attributed to a gastrointestinal (GI) source. Often, this occurs despite the presence of dyspnea or diaphoresis, symptoms that are difficult to attribute to the GI system. Additionally, patients with myocardial ischemia may report relief or improvement with GI remedies (eg, antacids). […] The discomfort of myocardial ischemia may also erroneously be attributed to a musculoskeletal etiology. Tenderness of the chest wall is reported in as many as 5% of patients who are diagnosed with myocardial infarction (MI). If no injury or event is defined that could have led to a soft-tissue injury, the clinician should be reluctant to render a diagnosis of musculoskeletal chest pain. […] Younger patients are overly represented in cases of missed MI. Most likely this is because of the inherent bias that MI is a disease of middle-aged and older individuals. Each patient with chest symptoms should be approached as an individual who could have the disease.

• #39 Myocardial ischemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/symptoms-causes/syc-20375417

  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: […] Atherosclerosis is the most common cause of myocardial ischemia. […] 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. […] Coronary artery spasm is an uncommon cause of myocardial ischemia. […] Myocardial ischemia can lead to serious complications, including: […] 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. […] Over time, repeated episodes of ischemia may lead to heart failure.

• #40 Myocardial ischemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/diagnosis-treatment/drc-20375422

  The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both. […] Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include: […] 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.

• #41 Myocardial Ischemia: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17848-myocardial-ischemia

  Myocardial ischemia is a lack of blood flow getting to your heart muscle. That means your heart muscle isnt getting enough blood to do what it needs to do. Often, the cause is a collection of fat and cholesterol (plaque) that doesnt let enough blood go through your coronary arteries. Medicines and surgeries can treat myocardial ischemia. […] Myocardial ischemia (or cardiac ischemia) means your heart muscle is not getting enough blood (which contains oxygen and nutrients) to work as it should. If this lack of blood from your coronary arteries is severe or goes on for more than a few minutes, it can damage your heart muscle. Then it becomes a myocardial infarction (heart attack). […] Each year, more than 1 million people in the United States die from myocardial infarction (heart attack). This is due to myocardial ischemia, a lack of blood flow and oxygen to your heart muscle.

• #42 Silent Myocardial Ischemia: Diagnosis, Treatment, and Prognosis | Consultant360

  https://www.consultant360.com/content/silent-myocardial-ischemia-diagnosis-treatment-and-prognosis

  Silent myocardial ischemia is a major component of the total ischemic burden for patients with coronary artery disease (CAD); it is estimated that between 2 and 3 million persons with stable CAD have evidence of silent ischemia. […] In the United States, an estimated 2 to 3 million persons with stable coronary artery disease (CAD) have evidence of silent ischemia. […] Greater awareness of the incidence of silent ischemia in high-risk populations (eg, persons with diabetes) can help reduce cardiovascular events and death rates. […] We also offer recommendations for the diagnosis and management of SMI. […] According to the Cohn classification, patients with silent ischemia are stratified into types I, II, or III. […] In patients with ischemic heart disease, SMI occurs more often than does the typical episode of angina.

• #43 Myocardial ischemia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/myocardial-ischaemia?lang=us

  Myocardial ischemia refers to the result of a mismatch between myocardial oxygen supply and demand as a consequence of the cessation of blood flow resulting in reversible injury or myocardial cell death if prolonged and associated with a loss of contractile function. […] Initial clinical workup of ischemia includes ECG and biochemical biomarkers of cardiomyocyte injury especially in the setting of an acute situation. […] The choice of imaging modalities in suspected myocardial ischemia depends on presenting symptoms and their temporal course, the clinical likelihood of obstructive coronary artery disease, patient comorbidities as well as clinical parameters like ECG, myocardial necrosis markers and others. […] Invasive coronary angiography (ICA) is the modality of choice in the clinical setting of acute coronary syndrome and/or severe symptoms refractory to medical therapy and a high pretest probability of coronary artery disease (CAD).

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