Ischemia Symptoms, Causes, Treatment, and Prognosis

Picture of brain ischemia.

• Ischemia is a condition in which the blood vessels become blocked, and blood flow is stopped or reduced.
• When blood flow is diminished to a body part, that body part also does not receive adequate oxygen.
• Ischemia can occur anywhere in the body, including the
  • brain (cerebral ischemia), 
  • heart (ischemic heart disease, myocardial ischemia, or cardiac ischemia), and 
  • legs (critical limb ischemia - a form of peripheral artery disease), and intestines (acute mesenteric ischemia or bowel ischemia).

There are not so much different types of ischemia (all ischemia involves a blocked blood vessel) as there are different names depending on the body part affected, for example:

1. Cardiac ischemia also called (ischemic heart disease and myocardial ischemia) is decreased blood flow and oxygen to the heart muscle.
2. Cerebral ischemia is decreased blood flow to the brain. There are 2 types of cerebral ischemia: 
3. Focal ischemia, which is localized in a specific region of the brain [in the form of a stroke or transient ischemic attack (TIA)]
4. Global ischemia, which involves large areas of brain tissue
5. Critical limb ischemia, a form of peripheral artery disease, is decreased blood flow to the legs or arms
6. Mesenteric ischemia is decreased blood flow to the intestines. Ischemic colitis is reduced blood flow to the large intestine (colon). 
7. Cutaneous ischemia involves decreased blood flow to the skin. 
8. Cyanosis is bluish or purplish discoloration of skin due to circulatory problems and low blood oxygen (hypoxia)
9. Gangrene is tissue death that results from lack of blood flow

Other researchers divide Ischemia into only two types, thrombotic and embolic: 

1. Thrombotic ischemia occurs when the blockage occurs in an artery that provides blood to an area or organ like the brain
2. Embolic ischemia occurs when a blood clot or plaque formed at another body site breaks off and flows in the blood to another body site and then lodges in an artery (example – femoral artery produces clots that flow in the blood and then block small arteries that supply the toes)
    

Ischemia in the heart and brain often causes no symptoms, and is sometimes referred to as “silent ischemia,” and the first sign may be an unexpected heart attack or stroke. When signs and symptoms of ischemia do occur, they depend on where it  is in the body.  

Ischemia of the Heart Symptoms and Signs

If ischemia occurs in the heart, symptoms may include: 

1. Chest pain (angina)
2. Shortness of breath
3. Fast heartbeat
4. Shoulder or back pain
5. Neck, jaw, or arm pain
6. Sweating/clamminess
7. Nausea/vomiting
8. Fatigue
9. Dizziness or lightheadedness

Ischemia of the Brain Symptoms and Signs

If ischemia occurs in the brain, symptoms may include: 

1. Sudden headache
2. Dizziness
3. Vomiting 
4. Fainting
5. Problems moving the body, problems with coordination, numbness
6. Weakness in arm or leg or one side of face
7. Problems speaking/slurred speech
8. Vision problems/blindness

Ischemia of the Legs Symptoms and Signs

If ischemia occurs in the legs, symptoms may include: 

1. Severe pain in legs and feet while at rest
2. Sores on the feet or legs that don’t heal
3. Foot pain or numbness
4. Shiny, smooth skin on legs and feet
5. Thickened toenails
6. Coldness or weakness in the legs
7. Dry, black skin (dry gangrene) in the legs or feet

Ischemia of the Intestines Symptoms and Signs

If ischemia occurs in the intestines, symptoms of intestinal ischemia may include: 

1. Sudden, severe stomach pain
2. Severe pain within 15-60 minutes after eating
3. Nausea/vomiting
4. Diarrhea
5. Gas (flatulence)
6. Bloating
7. Weight loss
8. Blood in the stool
9. Feeling of needing to have a bowel movement

A primary cause of ischemia is atherosclerosis (hardening of the arteries). Plaque, a hard, sticky substance composed mostly of fat builds up within the arteries, causing narrowing and stiffening. This reduces blood flow. 

Other causes of ischemia may include:

• Low blood pressure (hypotension) as a result of heart attack or shock
• Congenital heart defects
• Sickle cell anemia
• Blood clots in arteries
• Compression or blockage of a blood vessel (from a tumor or musculoskeletal abnormality)
• Anemia
• Microvascular blockages from blood abnormalities (abnormal cells in Sickle Cell disease, hyperviscosity syndromes from cancers, or septic emboli)

Once a doctor has reviewed your history and done a physical exam, tests may be ordered depending on the location of suspected ischemia. 

In general, tests for ischemia anywhere in the body may include:

• Doppler ultrasound
• CT angiogram (CTA)
• Angiogram 
• Magnetic resonance angiography (MRA)

If ischemia is suspected in the heart, tests may also include: 

• Electrocardiogram (ECG or EKG)
• Blood tests 
• Cardiac catheterization
• Holter monitor 
• Radionuclide imaging (thallium stress test)
• Stress testing

If ischemia is suspected in the brain, tests may also include: 

• Auscultation of arteries in the neck with a stethoscope
• CT scan
• Digital-subtracted cerebral angiogram (DSA) 
• Single photon emission computerized tomography (SPECT) scan
• Brain MRI

If ischemia is suspected in the legs, tests may also include: 

• Auscultation, performed using a stethoscope
• Ankle-brachial index (ABI)
• Ultrasounds
• CT scan arteriogram
   

Medications used to treat various types of ischemia include anti-platelet drugs and anticoagulants. Endovascular treatment such as balloon angioplasty and implanting stents may be performed, which open the narrowed or blocked blood vessels. 

Other treatments for ischemia may vary depending on the part of the body affected. 

Ischemia in the heart, brain, abdomen, or extremities can be life-threatening and ischemia in other parts of the body can be serious. See a doctor if you experience any symptoms of ischemia.

Call 911 and go to an emergency department if you have:

• Chest pain
• Difficulty breathing
• Stroke symptoms (arm or leg weakness, numbness, dizziness, trouble talking, dizziness, or sudden loss of vision)
• Severe abdominal pain
• Cold or blue and numb extremity like a leg or arm or finger

• Ischemia can be very serious, even fatal. 
• Ischemia in the heart can lead to heart attack (myocardial infarction)
• Ischemia in the brain can lead to stroke
• Ischemia in the legs can lead to severe leg pain and difficulty walking and/or infections and loss of the limb
• Ischemia in the intestines can lead to death of part of the intestines

Ischemia may be prevented in some cases by preventing atherosclerosis. This includes lifestyle modifications that include:

• Eat a healthy balanced diet including plenty of fruits, vegetables, and whole grains
• Exercise regularly
• Use stress reduction techniques such as mediation or yoga
• Don’t smoke
• Keep diabetes, high blood pressure, and high cholesterol under control
• See your doctor regularly for checkups