A Resource for
Nuclear Lab Professionals

The Ischemic Cascade

  • The ischemic cascade is a sequence of hemodynamic and cardiac electrophysiologic changes that culminate in angina1
  • It is initiated by an imbalance between myocardial oxygen supply and demand1
  • Abnormal myocardial perfusion is the first detectable event in the ischemic cascade2


  1. Nesto RW, Kowalchuk GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol. 1987;57:23C-30C.

  2. Michelena HI, VanDecker WA. Radionuclide-based insights into the pathophysiology of ischemic heart disease: beyond diagnosis. J Invest Med. 2005;53:176-191.

  3. Holban I, Goldenberg P. Rationale for a metabolic intervention in obese patients with coronary heart disease. Heart Metab. 2002;17:27-31.