Ischemia

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Introduction

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 in abdominal pain, bloody stool, and even intestinal rupture or gangrene. Peripheral ischemia can lead to loss of fingers or toes or the need for limb amputation.

Pain is a common symptom associated with ischemia, but does not always occur. Brain ischemia can cause cognitive, sensory or motor problems. Heart attacks and intestinal ischemia can cause nausea and vomiting. Peripheral ischemia can cause pallor, bluish discoloration, or darkening of the skin of the nose, ears, fingers, toes, or other surface areas.

Risk 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. Treatment of ischemia depends on the cause, but generally is aimed at restoring blood flow and reducing further tissue injury and death.

Because ischemia can lead to permanent injury, 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.

Symptoms

What are the symptoms of ischemia?

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

Common symptoms of ischemia of the heart

Symptoms of cardiac ischemia include:

  • Chest pain or pressure, which may radiate to the back, arm, shoulder, neck, jaw or stomach
  • Limitations of physical abilities
  • Nausea with or without vomiting
  • Palpitations or irregular heart rhythms
  • Profuse sweating
  • Shortness of breath

Common symptoms of ischemia of the brain

Symptoms of ischemia of the brain include:

  • Abnormal pupil size or nonreactivity to light
  • Balance problems, difficulty walking, and falls
  • Confusion
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Dizziness
  • Droopy eyelid
  • Headache
  • Loss of muscle coordination
  • Loss of vision or changes in vision
  • Nausea with or without vomiting
  • Numbness or weakness
  • Paralysis
  • Vision problems (double vision, blurriness, loss of visual field, sudden blindness)
  • Weakness (loss of strength)

Common symptoms of other types of ischemia

Symptoms from ischemia in other parts of the body can include:

  • Abdominal discomfort when eating
  • Bloody stool (the blood may be red, black, or tarry in texture)
  • Diarrhea
  • Leg pain with walking or climbing stairs
  • Nausea with or without vomiting
  • Non-healing sores
  • Pain
  • Skin changes

Serious symptoms that might indicate a life-threatening condition

In some cases, ischemia can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Abnormal pupil size or nonreactivity to light
  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Chest pain, chest tightness, chest pressure, palpitations
  • Droopy eyelid
  • Garbled or slurred speech or inability to speak
  • Hallucinations
  • Paralysis or inability to move a body part
  • Respiratory or breathing problems such as shortness of breath
  • Seizure
  • Severe abdominal pain or headache
  • Sudden change in vision, loss of vision
  • Vomiting blood or bloody stool
Causes

What causes ischemia?

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

What are the risk factors for ischemia?

A number of factors increase the risk of developing ischemia. Not all people with risk factors will get ischemia. Risk factors for ischemia include:

  • Atrial fibrillation or other heart disease
  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
  • High blood pressure
  • High cholesterol or triglycerides
  • Increasing age
  • Male gender
  • Obesity or being overweight
  • Physical inactivity
  • Stress
  • Tobacco use
  • Trauma
  • Underlying vascular disease
  • Venous thromboembolism

Reducing your risk of ischemia

You may be able to lower your risk of ischemia by:

  • Controlling your blood sugar
  • Eating a healthy diet
  • Engaging in physical activity
  • Maintaining a healthy weight
  • Quitting smoking and other tobacco products
  • Reducing your stress level
  • Taking medications as recommended for heart disease, cholesterol, diabetes, or high blood pressure
Treatments

How is ischemia treated?

Treatment of ischemia begins with seeking regular medical care throughout your life. Regular medical care allows a health care professional to provide early screening tests and to promptly evaluate symptoms and your risks for developing ischemia.

The goal of treating ischemia is to restore blood flow and prevent further damage. Surgery may be needed to remove dead tissue or repair injured areas. Once the initial event is managed, treatment turns to prevention of future ischemia.

Common treatments of acute or chronic ischemia

Common treatments to reduce ischemia and restore blood flow include:

  • Medications to control pain and dilate blood vessels
  • Medications to prevent ongoing clot formation
  • Medications to reduce the heart’s workload
  • Oxygen therapy
  • Procedures to expand blood vessels
  • Surgery or procedures to remove clots
  • Surgery to bypass blocked blood vessels
  • Thrombolytic drugs to dissolve clots

What are the potential complications of ischemia?

Complications of untreated ischemia can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of ischemia include:

  • Altered or decreased sensation
  • Amputation
  • Blindness
  • Bowel perforation or loss
  • Decreased cognitive function
  • Heart failure
  • Paralysis or weakness
  • Permanent disability
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Silent ischemia and ischemic heart disease. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Silent-Ischemi....
  2. Intestinal ischemia. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/ischemia.asp
  3. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
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