Cardiac Ischemia (Myocardial Ischemia)

Cardiac ischemia, also called myocardial ischemia, means the heart muscle is not getting enough oxygen-rich blood. The most common cause is coronary heart disease, where plaque made of fat, cholesterol, and other substances builds up in the arteries that feed the heart. The National Heart, Lung, and Blood Institute notes that coronary heart disease is also sometimes called ischemic heart disease.

Ischemia can be silent, or it can cause angina, a squeezing chest pain that often comes on with exertion. If an artery becomes completely blocked, the affected muscle begins to die, which is a heart attack. According to NHLBI, coronary heart disease is the most common type of heart disease and caused 371,506 deaths in the United States in 2022.

Ischemic heart events come up in litigation when a drug, device, or product is alleged to have raised the risk of heart attack or stroke. Historic examples include lawsuits over painkillers and diabetes drugs that were later linked to cardiovascular risk, and over testosterone products. The gout drug febuxostat (Uloric) received an FDA boxed warning in February 2019 for a higher rate of cardiovascular death compared with allopurinol in patients with existing heart disease.

The hardest part of these cases is causation, because heart disease is so common. Lawyers and courts look for strong studies showing increased risk, a clear timeline, and the absence of other explanations. If you had a heart attack while taking a medication under investigation, keep your cardiology records and pharmacy history. Read about how these cases are organized in our guide to multidistrict litigation.