What is Ischemia? Symptoms and Treatment
Ischemia is a condition in which blood flow to the tissue decreases and the tissue’s oxygen needs cannot be met. It can be seen in every tissue in the body. Ischemia, especially in the heart and brain, can cause serious health problems that can be life-threatening.
What is Ischemia?
Tissues need oxygen and nutrients to survive. The structures that deliver these substances to the tissues are blood vessels. Obstruction in any large or small vessel in the body causes ischemia. In case of ischemia, damage occurs to the tissue fed by the blocked vessel.
One of the most common causes of ischemia is atherosclerosis. In atherosclerosis; A hard and sticky plaque consisting mostly of fat begins to form inside the vein. Plaque formation is a time-consuming process. Therefore, the person may not notice this situation at first. The plaque gradually hardens, reducing the diameter of the vessel and causing the vessel to narrow. As a result, blood flow in the narrowed vessel decreases.
Another cause of ischemia is blood clots. While the plaque that forms in the veins is a problem in itself, it can also burst and form a clot. This may cause the blood flow in the vein to stop suddenly. In some cases, the blood clot breaks into smaller pieces and can travel to other parts of the body, causing ischemia in that area.
Ischemia can cause serious damage to tissues. The most common problems caused by ischemia can be listed as follows:
Heart: Ischemia occurring in the heart; Also known as myocardial ischemia or cardiac ischemia. This may cause heart diseases such as heart attack, arrhythmia (irregular heartbeat), and heart failure . Ischemia can also lead to chest pain called ‘angina’ and sudden cardiac death.
Brain: Cerebral ischemia or brain ischemia can cause a person to have a stroke.
Legs: Ischemia in the legs may occur in association with peripheral artery disease. This condition, caused by plaque formation in the leg arteries (arteries), can lead to severe pain that does not go away even at rest. If leg ischemia is not treated, serious conditions may occur that may cause the patient to lose his or her leg.
Intestines: Mesenteric ischemia is a condition that can affect both the small intestine and the large intestine. In mesenteric ischemia, the part of the intestine that cannot be fed properly due to reduced blood flow may die or become perforated.
What are the Symptoms of Ischemia?
Ischemia symptoms may vary depending on the tissue in which ischemia occurs. Sometimes patients may not have any symptoms due to ischemia. This condition, defined as silent ischemia, is encountered especially in ischemia in the heart or brain. When patients with silent ischemia experience a heart attack or stroke, it seems like an unexpected event. However, there is a long-standing ischemic process in the patient’s organs. Ischemia in different organs causes different symptoms. Not all symptoms caused by ischemia may be seen in every patient.
Symptoms that occur in case of myocardial ischemia:
- Chest pain (angina)
- Faster heart rate than normal (tachycardia)
- Pain radiating to the neck, jaw, arm and shoulder
- Shortness of breath
- excessive sweating
- Nausea, vomiting
- It is in the form of fatigue and exhaustion.
Ischemia in the brain can cause the following symptoms:
- Severe and sudden headache, sometimes accompanied by dizziness and vomiting
- fainting
- Difficulty moving the body (numbness, weakness, or inability to move the face, arm, or leg on one side of the body)
- Inability to speak clearly and understand what other people are saying
Symptoms that occur in case of ischemia in the legs:
- Coldness and weakness in legs
- Feeling of pain in the foot
- Pain in the legs that persists even at rest
- Shiny, smooth appearance of leg and foot skin
- It can be considered as a non-healing wound on the leg.
Mesenteric ischemia, that is, ischemia seen in the intestines:
- Severe abdominal pain
- Swelling
- Bloody stool (feces)
- Diarrhea
- Feeling of not being able to go to the toilet properly
- It may cause symptoms such as nausea and vomiting.
How is Ischemia Treated?
The main goal in the treatment of acute ischemia is to increase blood flow to the tissue by widening the narrowed vessel. Myocardial ischemia treatment is aimed at improving the blood supply to the heart muscle. For this, both drug treatments and surgical methods can be used.
Drugs that can be preferred for the treatment of myocardial ischemia:
- Aspirin
- Nitrates
- Beta blockers
- Calcium channel blockers
- Cholesterol lowering agents
- Angiotensin-converting enzyme (ACE) inhibitors
- It can be listed as Ranolazine.
Some of these drugs can be used in the treatment of acute ischemia and some in the treatment of chronic ischemia. In some cases, invasive procedures may be required to restore blood flow to the heart. These operations:
Angioplasty: In this procedure, a thin tube-shaped device is generally advanced from the femoral artery (artery in the groin) towards the heart. When the narrowed vessel in the heart is reached, the balloon-like structure inside the device is inflated. A stent may be placed in the relevant area to prevent the corrected vessel from narrowing again.
Bypass Surgery: In this surgery, the vessels causing ischemia are replaced with vessels taken from another part of the body. Since bypass is performed as an open surgery, it is generally performed on patients who have problems in more than one vessel and cannot be treated with angioplasty. Cerebral ischemia can cause a serious condition in the brain called ischemic stroke. In order to prevent ischemic stroke from causing extensive damage to the brain, it must be treated urgently at an early stage. The aim of ischemic stroke treatment is to normalize the blood flow to the brain. Treatment methods that can be applied for this:
Intravenous (IV) Administration of Medicine: In order for this treatment to be applied, the patient must apply to a well-equipped health center at least a few hours after the first symptom appears. In this method, the patient is given a drug called tissue plasminogen activator (tPA) intravenously. tPA dissolves the blood clot that causes ischemia in the brain and improves blood flow to the brain. In this way, it is possible to save the patient without serious damage to the brain. The earlier tPA is given to the patient, the less likely it is that the patient will develop brain damage.
Endovascular Procedures: In these procedures, the treatment is applied directly to the vessel where the blockage is located. As in heart angioplasty, a stent can be placed in the vein or various medications are administered to the vein to eliminate the clot.
Angioplastic methods, bypass surgery or clot dissolving drugs can be used to remove the obstruction in the leg vein. To determine which treatment to apply, the doctor takes into account parameters such as the location of the blocked vessel, the severity of the blockage, and the general condition of the patient.
Sudden mesenteric ischemia needs to be treated urgently. In acute mesenteric ischemia, blood flow to the intestine suddenly stops. This causes the relevant intestinal tissue to die. Sometimes this tissue may be punctured and the intestinal contents may disperse into the abdominal cavity. Intestinal content is not sterile and contains many bacteria. Abdominal infection may develop as a result of this content dispersing into the abdominal cavity. To prevent perforation of the intestine, the section of dead intestine that is not properly blooded can be surgically removed.
In chronic mesenteric ischemia, the blocked vessel can be opened with a balloon and a stent can be placed to improve the blood circulation of the intestine. Ischemia is a condition that causes very serious health problems. It is of great importance to recognize ischemia at an early stage in order to minimize ischemia-related damage to tissues and organs. People showing symptoms of ischemia should contact the nearest health center without delay. The patient can be treated successfully by immediately restoring the blood circulation stopped in acute ischemia. Since silent ischemia does not cause symptoms, regular general health checks should be performed for early diagnosis of this condition.
