environment applies to all the external factors that have a formative influence on one's physical, mental, or moral development. the kind of environment that produces juvenile delinquents; milieu applies especially to the physical and social surroundings of a person or group of persons.
Myocardial ischemia is an imbalance between myocardial oxygen supply and demand. Left untreated, it results in angina pectoris, myocardial stunning, myocardial hibernation, ischemic preconditioning, postconditioning, or under the most severe instances, acute coronary syndrome and myocardial infarction.
(See Criteria for the diagnosis of acute myocardial infarction, section on 'Third universal definition of MI'.) Clinical evidence of myocardial ischemia is necessary because serum/plasma troponin elevations may reflect myocardial injury that is not necessarily due to an acute coronary syndrome (ACS).