What is ischemia?

Ischemia is any reduction in blood flow resulting in decreased oxygen and nutrient supplies to a tissue. Ischemia may be reversible, in which case the affected tissue will recover if blood flow is restored, or it may be irreversible, resulting in tissue death. Ischemia can also be acute, due to a sudden reduction in blood flow, or chronic, due to slowly decreasing blood flow. Ischemia can occur anywhere in the body. Heart attacks and strokes can both result from ischemia. Although less well known, ischemia can also affect the intestines, resulting inabdominal pain, bloody stool, and even intestinal rupture or gangrene. eripheral ischemia can lead to loss of fingers or toes or the need for limb amputation. ain is a common symptom associated with ischemia, but does not always occur. !rain ischemia can cause cognitive, sensory or motor problems. Heart attacks and intestinal ischemia can cause nauseaand vomiting. eripheral ischemia can cause pallor, bluish discoloration, or darkening of the skin of the nose, ears, fingers, toes, or other surface areas. "isk factors for ischemia include vascular diseases, such as arteriosclerosis #hardening of the arteries$, trauma, high blood pressure, heart problems, diabetes #chronic disease that affects your body%s ability to use sugar for energy$, tobacco use, high cholesterol, physical inactivity, stress, family history of ischemic diseases, and increasing age. &reatment of ischemia depends on the cause, but generally is aimed at restoring blood flow and reducing further tissue in'ury and death. !ecause ischemia can lead to permanent in'ury, acute ischemia is always a medical emergency. Seek immediate medical care (call 911) for chest pain or pressure( difficulty breathing( severe headache( abdominal pain( sudden difficulty with memory, thinking, talking, comprehension, writing or reading( confusion or loss of consciousness for even a brief moment( numbness( paralysis or inability to move a body part( loss of vision or changes in vision( impaired balance and coordination( vomiting blood, rectal bleeding or bloody stool( profuse sweating( unusual anxiety( or a cold, blue or darkened extremity or patch of skin. Seek prompt medical care if you are being treated for ischemia but mild symptoms recur or are persistent, or if you start to develop mild shortness of breath, limitation of physical abilities, gradual memory loss, gradual skin changes, non)healing sores on the leg or foot, leg pain with walking or climbing stairs, abdominal discomfort while eating, or other symptoms that cause you concern.

What are the symptoms of ischemia?

Although pain is a common, ischemia may occur without any symptoms. *enerally, symptoms depend on the location of the ischemia.

+ommon symptoms of ischemia of the heart

,ymptoms of cardiac ischemia include+hest pain or pressure, which may radiate to the back, arm, shoulder, neck, 'aw or stomach .imitations of physical abilities /ausea with or without vomiting alpitations or irregular heart rhythms rofuse sweating ,hortness of breath

What causes ischemia?

Ischemia is caused by a decrease in blood supply to a tissue or organ. !lood flow can be blocked by a clot or constriction of an artery. It can occur due to gradual thickening of the artery wall and narrowing of the artery, as in atherosclerosis. &rauma can also disrupt blood flow.

What are the risk factors for ischemia?

A number of factors increase the risk of developing ischemia. /ot all people with risk factors will get ischemia. "isk factors for ischemia includeAtrial fibrillation or other heart disease 0iabetes #chronic disease that affects your body%s ability to use sugar for energy$ High blood pressure High cholesterol or triglycerides

Increasing age 1ale gender 2besity or being overweight hysical inactivity ,tress &obacco use 3nderlying vascular disease

ow is ischemia treated?
&reatment of ischemia begins with seeking regular medical care throughout your life. "egular medical care allows a health care professional to provide early screening tests and to promptly evaluate symptoms and your risks for developing ischemia. &he goal of treating ischemia is to restore blood flow and prevent further damage. ,urgery may be needed to remove dead tissue or repair in'ured areas. 2nce the initial event is managed, treatment turns to prevention of future ischemia.

+ommon treatments of acute or chronic ischemia

+ommon treatments to reduce ischemia and restore blood flow include1edications to control pain and dilate blood vessels 1edications to prevent ongoing clot formation 1edications to reduce the heart%s workload 2xygen therapy rocedures to expand blood vessels ,urgery or procedures to remove clots ,urgery to bypass blocked blood vessels &hrombolytic drugs to dissolve clots

What are the potential complications of ischemia?

+omplications of untreated ischemia can be serious, even life threatening in some cases. 4ou can help minimi5e your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. +omplications of ischemia includeAltered or decreased sensation Amputation !owel perforation or loss 0ecreased cognitive function Heart failure aralysis or weakness In medicine, ischemia, also spelled as ischaemia or ischmia, #6skim76(89:8;: from *reek language <=>?<@A?, ischaima( isch- root denoting a restriction or thinning or to make or grow thin6lean, haema blood$ is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism #to keep tissue alive$.8B: Ischemia is generally caused by problems withblood vessels, with resultant damage to or dysfunction of tissue. It also means local anemia in a given part of a body sometimes resulting from congestion #such as vasoconstriction, thrombosis or embolism$. Ischemic means having or showing symptoms of ischemia, while nonischemic means Cnot related to or showing signs of ischemiaC.

Causes
An inadeDuate flow of blood to a part of the body may be caused by any of the following &horacic 2utlet ,yndrome #compression of the brachial plexus$ Atherosclerosis #lipid)laden plaDues obstructing the lumen of arteries$ Hypoglycemia #lower than normal level of glucose$

&achycardia #abnormally rapid beating of the heart$ Hypotension #low blood pressure, e.g. in septic shock, heart failure$ &hromboembolism #blood clots$ 2utside compression of a blood vessel, e.g. by a tumor or in the case of superior mesenteric artery syndrome Embolism #foreign bodies in the circulation, e.g. amniotic fluid embolism$ ,ickle cell disease #abnormally shaped red blood cells$ Induced g)forces which restrict the blood flow and force the blood to the extremities of the body, as in acrobatics and military flying .ocali5ed extreme cold, such as by frostbite or improper cold compression therapy &ourniDuet application An increased level of glutamate receptor stimulation arteriovenous malformations, and peripheral artery occlusive disease rupture of significant blood vessels supplying a tissue or organ. Anemia vasoconstricts the periphery so that red blood cells can work internally on vital organs such as the heart, brain, etc., thus causing lack of oxygen to the periphery.

Consequences
Further information: ischemic cascade, stroke, and heart attack ,ince oxygen is carried to tissues in the blood, insufficient blood supply causes tissue to become starved of oxygen. In the highly aerobic tissues of the heart and brain, irreversible damage to tissues can occur in as little as BFG minutes at body temperature. &he kidneys are also Duickly damaged by loss of blood flow. &issues with slower metabolic rates may undergo irreversible damage after ;H minutes. Ischemia results in tissue damage in a process known as ischemic cascade. &he damage is the result of the build)up of metabolic waste products, inability to maintain cell membranes, mitochondrial damage, and eventual leakage of autoly5ing proteolytic en5ymes into the cell and surrounding tissues. "estoration of blood supply to ischemic tissues can cause additional damage known as reperfusion in'ury that can be more damaging than the initial ischemia. "eintroduction of blood flow brings oxygen back to the tissues, causing a greater production of free radicals and reactive oxygen species that damage cells. It also brings more calcium ions to the tissues causing further calcium overloading and can result in potentially fatal cardiac arrhythmias and also accelerates cellular self)destruction. &he restored blood flow also exaggerates the inflammation response of damaged tissues, causing white blood cells to destroy damaged cells that may otherwise still be viable.8G: [edit]Cardiac

ischemia

+ardiac ischemia may be asymptomatic or may cause chest pain, known as angina pectoris. It occurs when the heart muscle, or myocardium, receives insufficient blood flow. &his most freDuently results from atherosclerosis, which is the long)term accumulation of cholesterol)rich plaDues in the coronary arteries. Ischemic heart disease is the most common cause of death in most Western countries and a ma'or cause of hospital admissions. 8I: [edit]Bowel !oth large and small bowel can be affected by ischemia. Ischemia of the large intestine may result in an inflammatory process known as ischemic colitis. Ischemia of the small bowel is called mesenteric ischemia. [edit]Brain !rain ischemia is insufficient blood flow to the brain, and can be acute #i.e., rapid$ or chronic #i.e., long)lasting$. Acute ischemic stroke is a neurologic emergency that may be reversible if treated rapidly. +hronic ischemia of the brain may result in a form of dementia called vascular dementia. [edit]Lim Main article: Acute limb ischaemia .ack of blood flow to a limb results in acute limb ischemia.

[edit]Cutaneous "educed blood flow to the skin layers may result in mottling or uneven, patchy discoloration of the skin [edit]!reatment 0ecrease in body temperature reduces the aerobic metabolic rate of the affected cells, reducing the immediate effects of hypoxia. "eduction of body temperature also reduces the inflammation response and reperfusion in'ury. Jor frostbite in'uries, limiting thawing and warming of tissues until warmer temperatures can be sustained may reduce reperfusion in'ury. Jor blood clots, administration of Cclot)busterC drugs such as Alteplase within the critical time period, together with some collateral circulation to the ischemic area is a main factor in patient recoveries. 2ther drug therapies such as cannabinoids and hydrogen sulfide are being researched for limiting ischemic in'uries.

What Are The Symptoms of Cardiac Ischemia?

The American Heart Association has created a table of symptoms and warning signs of which everyone should be aware. Sign or Symptom Shortness of breath (also called dyspnea) Why It Happens Blood "bac s up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can!t eep up with the supply. This causes fluid to lea into the lungs. People with Heart Failure May Experience... . . breathlessness during activity (most commonly)" at rest" or while sleeping" which may come on suddenly and wa e them up. They often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. They often complain of wa ing up tired or feeling an#ious and restless.

$ersistent coughing or whee%ing Buildup of e#cess fluid in body tissues (edema)

&luid builds up in the lungs (see above).

. . . coughing that produces white or pin blood'tinged mucus.

As blood flow out of the heart slows" blood returning to the heart through the veins bac s up" causing fluid to build up in the tissues. The idneys are less able to dispose of sodium and water" also causing fluid retention in the tissues. The digestive system receives less blood" causing problems with digestion. )hanging levels of certain substances in the blood" such as sodium" can cause confusion. To "ma e up for" the loss in pumping capacity" the heart beats faster. The heart can!t pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs" particularly muscles in the limbs" and sends it to the heart and brain.

. . . a tired feeling all the time and difficulty with everyday activities" such as shopping" climbing stairs" carrying groceries or wal ing.

(ac of appetite" nausea )onfusion" impaired thin ing *ncreased heart rate Tiredness" fatigue

. . a feeling of being full or sic to their stomach. . . memory loss and feelings of disorientation. A caregiver or relative may notice this first. . . heart palpitations" which feel li e the heart is racing or throbbing. . . a tired feeling all the time and difficulty with everyday activities" such as shopping" climbing stairs" carrying groceries or wal ing.

Myocardial ischemia occurs when blood flow to your heart muscle is decreased by a partial or complete blockage of your heart's arteries (coronary arteries). The decrease in blood flow reduces your heart's oxygen supply. Myocardial ischemia, also called cardiac ischemia, can damage your heart muscle, reducing its ability to pump efficiently. A sudden, severe blockage of a coronary artery may lead to a heart attack. Myocardial ischemia may also cause serious abnormal heart rhythms. Treatment for myocardial ischemia is directed at improving blood flow to the heart muscle and may include medications, a procedure to open blocked arteries or coronary artery bypass surgery. Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia. ome people who have myocardial ischemia don't experience any signs or symptoms (silent ischemia). When myocardial ischemia does cause signs and symptoms, they may include: Chest pressure or pain, typically on the left side of the body (angina pectoris) Neck or jaw pain Shoulder or arm pain Clammy skin Shortness of breath Nausea and vomiting Along with a review of your medical history and a thorough physical exam, the tests and procedures used to diagnose myocardial ischemia include:

Electrocardiogram (ECG). This test records the electrical activity of your heart via electrodes attached to your skin. Certain abnormalities in your heart's electrical activity may indicate myocardial ischemia.

Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged. To help diagnose myocardial ischemia, your doctor may take samples of your blood to test for these enzymes.

Echocardiogram. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn't pumping normally.

Nuclear scan. This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it flows through your heart and lungs. Areas of reduced blood flow to the heart muscle through which less of the radioactive material flows appear as dark spots on the scan.

Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.

Cardiac CT scan. CT scans can determine if you have coronary artery calcification a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (CT coronary angiogram).

Stress test. A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. Because exercise makes your heart pump harder and faster than it does during most daily activities, a stress test can reveal problems within your heart that might not be noticeable otherwise. It can be particularly useful if your doctor suspects you may have myocardial ischemia but you don't have any signs or symptoms.

Holter monitoring. A Holter monitor is a small, wearable device that records your heart rhythm. You usually wear a Holter monitor for one to three days. During that time, the device will record all of your heartbeats. A Holter monitor test is usually performed if an electrocardiogram isn't able to give your doctor enough information about your heart's condition or if your doctor suspects silent myocardial ischemia. Treatment of myocardial ischemia is directed at improving blood flow to the heart muscle. Depending on the severity of your condition, you may be treated with medications, undergo a surgical procedure or both. Medications Medications that can be used to treat myocardial ischemia include:

Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or if you're already taking another blood thinner, so ask your doctor before starting to take aspirin.

Nitroglycerin. This medication temporarily opens arterial blood vessels, improving blood flow to and from your heart.

Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.

Cholesterol-lowering medications. By decreasing the amount of cholesterol in your blood, especially low-density lipoprotein (LDL), or "bad," cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Boosting your high-density lipoprotein (HDL), or "good," cholesterol, may help, too. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.

Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels and lower blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including constricting your blood vessels.

Ranolazine (Ranexa). This medication helps relax your heart arteries. Ranolazine is an anti-angina medication that may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.