Ischemia

From one Ischemia one speaks in the case of a Reduced blood flow or a completely lost blood flow in a tissue area. Ischemia can occur anywhere in the body and, depending on its location, extent and duration, can be life-threatening.

What is ischemia?

The ischemia of a small area of ​​skin due to pressure damage may only be noticeable after many hours. A loss of blood flow in the brain, on the other hand, leads to unconsciousness in just 15-20 seconds and is acutely life-threatening, as irreparable necroses occur within 7-10 minutes.
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As Ischemia is the undersupply of a tissue area with blood. This could be insufficient blood flow or a complete stop of blood flow.

If ischemia lasts only for a short time, the tissue can usually recover quickly after reperfusion. In the case of prolonged ischemia, the disturbed metabolism leads to - possibly irreparable - tissue destruction.

How long ischemia can be tolerated depends v. a. depending on their location: Certain organ systems such as the central nervous system are particularly sensitive to a lack of oxygen, other tissues such as the skin can tolerate ischemia for several hours.

causes

The most common causes of a Ischemia are internal pathological changes in the cardiovascular system. Vascular constrictions (stenoses) caused by arteriosclerosis occur gradually and cause chronic ischemia.

Sudden vascular occlusions due to thrombosis or embolism lead to acute ischemia. The traumatic destruction of a blood vessel also causes a loss of blood flow. Less commonly, ischemia is caused externally, e.g. B. by tying off a body part for the purpose of hemostasis, by tumors or by chronic pressure load when bedridden.

The consequences for the metabolism of the affected area are the same in both cases: Due to the insufficient oxygen supply, more lactate is formed and the ischemic area is over-acidic (metabolic acidosis).

Due to the lack of energy, the cells can no longer maintain their particle and fluid balance: They swell and eventually drown. When necrosis begins, one speaks not only of ischemia, but of the clinical picture of infarction.

Symptoms, ailments & signs

Ischemia typically manifests itself as an acute clouding of consciousness. Those affected usually feel a slight drowsiness or tiredness, in the further course it can lead to unconsciousness and a coma. A mild ischemic stroke causes nausea and vomiting.

In addition, visual disturbances and visual field deficits can occur. Cerebral infarction is also characterized by pathological reflexes of the Babinski group and neurological deficits. If the cranial nerves are involved, swallowing disorders and a foreign body sensation occur in the throat. The language can be slurred and indistinct.

Many patients black out and do not remember the incident. Partial or complete memory loss can also occur, depending on the severity of the ischemia. Often, hemiplegia also occurs. Many of those affected can no longer move their arms or legs or can only move them with great effort.

However, paralysis of all extremities rarely occurs. In severe cases, the stroke leads to death within a few minutes. At first, breathing stops, which leads to an insufficient supply of oxygen to the brain and ultimately to brain death. The symptoms of ischemia are usually irreversible. Most of those affected suffer from long-term effects.

Diagnosis & course

The course of a Ischemia depends fundamentally on which organ system is affected. The ischemia of a small area of ​​skin due to pressure damage may only be noticeable after many hours.

A loss of blood flow in the brain, on the other hand, leads to unconsciousness in just 15-20 seconds and is acutely life-threatening, as irreparable necroses occur within 7-10 minutes. The working heart muscle is also very sensitive to a lack of oxygen and can only tolerate ischemia for a few minutes. Pain and shock are typical of major ischemias; the other clinical symptoms, however, differ greatly depending on the location.

Indications of severe limb ischemia are provided by the 6 P signs according to Pratt: Pain (Pain), pallor (Pallor), lack of pulse (Pulselessness), sensory disturbance (Paresthesia), paralysis (Paralysis), shock (Prostration). A thorough medical history is important, as vascular occlusions almost always precede previous illnesses.

The diagnosis of ischemia is supported by laboratory results, functional diagnostics (e.g. EKG) and imaging procedures (duplex sonography, catheter angiography, computer sonography or magnetic resonance tomography).

Complications

Ischemia can be life-threatening for a patient if it occurs over a long period of time. The poor blood circulation in the affected tissue can also lead to irreversible consequential damage to the entire body. The patients often suffer from dyspnoea or necrosis due to the lack of oxygen.

Furthermore, in the worst case scenario, it can also lead to a heart attack and ultimately to death of the patient. People can also experience brain failure and loss of consciousness in the process. Should this persist over a longer period of time, it can also lead to consequential damage to the brain, so that the patients suffer from paralysis or spasticity.

There is also pain, sensitivity disorders or severe paleness. In the case of ischemia, immediate treatment is required in order to avoid irreversible consequential damage and complications. Surgical interventions may also be necessary. As a rule, the life expectancy of the patient is significantly reduced and restricted by the ischemia. The further course of the disease depends on the cause of the disease.

When should you go to the doctor?

If the person concerned notices circulatory disorders, he should consult a doctor in good time. If you experience cold limbs, numbness on the skin, a sudden pale coloration of the face or sensory disorders, you should see a doctor. In the event of tenderness, general pain or discomfort, further examinations should be carried out to clarify the cause. If cardiac arrhythmias, palpitations, changes in blood pressure or clouding of consciousness occur, a doctor is required.

If you lose consciousness, an emergency doctor must be called. In these cases, the affected person suffers a life-threatening condition within a few minutes and requires immediate intensive care. If brain disorders occur, attention or concentration is interrupted and the person concerned suffers from a feeling of pressure inside the head, he should consult a doctor.

If there are signs of paralysis on the body, if no pulse can be felt and if the person concerned suddenly feels ill, medical care must be taken. A visit to a doctor is advisable in the event of a drop in performance, dizziness, unsteady gait and a loss of normal strength. Consult a doctor in the event of internal weakness, clouded perception, tiredness or fatigue. If the symptoms increase, a medical examination should take place as soon as possible, as an acute threat to life can arise.

Treatment & Therapy

The aim of every ischemia therapy is to restore an adequate blood supply to the ischemic area. Acute Ischemia with heart attack events require rapid action:

If there are no contraindications, drug systemic or local lysis therapy is attempted first. If this does not work or if the time window for the lysis therapy has already expired, vascular surgical revascularization is possible: surgical removal of a thrombus, vascular dilatation or bypass operations. Sometimes these procedures can be performed through catheters, in other cases they require major surgery.

In the case of subacute forms of ischemia, preventively expanding vascular prostheses (stents) are also used. In patients with ischemia, drug anticoagulation, i.e. H. a reduction in the tendency of blood to clot, useful to prevent (further) embolisms and thromboses. For example, heparin or vitamin K antagonists are given for this purpose. In addition, patients at risk of chronic ischemia are often given calcium antagonists, beta blockers and / or nitro preparations.

Outlook & forecast

The prognosis for ischemia is generally poor. Regardless of where it is located in the body, it leads to severe impairment of the quality of life or, in severe cases, to a life threat. The person concerned suffers from various complaints that are of increasing character. If left untreated, the affected person can be expected to die prematurely, as there is a risk of a heart attack.

Depending on the location of the reduced blood flow, the use of medical care can lead to lifelong impairments or a life-threatening situation. An early and comprehensive medical examination is necessary for a favorable prognosis. The longer treatment is delayed, the greater the likelihood of complications or permanent impairment. In addition to metabolic disorders, there is a risk of damage to the brain. Irreparable tissue damage occurs, which in severe cases leads to functional disorders in addition to the organ disorders.

In the case of acute ischemia, immediate action is necessary to ensure the survival of the person affected. Lifelong impairments and a reduced quality of life are to be expected, as sequelae occur. The overall performance is reduced and there may be restrictions in movement sequences or coordination. Everyday life has to be restructured, as usual tasks can usually no longer be adequately guaranteed after the incident.

prevention

One Ischemia Prevention can generally be taken with measures that keep the cardiovascular system healthy: with exercise, good nutrition with special attention to healthy fats and without cigarettes. Careful anticoagulation should be ensured in patients with pre-existing conditions such as cardiac arrhythmias that predispose to vascular occlusion, as well as those who are bedridden after operations. In addition, extremities may only be tied in an absolute emergency, because after prolonged ischemia, an amputation of the affected part of the body may be necessary.

Aftercare

After treatment by the attending physician, it is particularly important to ensure a healthy and balanced lifestyle in the case of ischemia. Refraining from alcohol and nicotine (in any form) is inevitable here. You should also pay attention to the cholesterol levels. Too high a cholesterol level can lead to further complications in the vascular system. Disturbances in lipid metabolism must be avoided at all costs.

Body weight should also be considered; Obesity can lead to other problems that the patient should absolutely avoid. Sports and sufficient exercise such as walks, jogging, team sports or cycling are supportive and in any case health-promoting. Continuous monitoring for high blood pressure and diabetes is also recommended.

A balanced diet high in fiber is also beneficial in follow-up care for ischemia. Dietary fiber not only lowers the cholesterol level, but also ensures healthy bowel function. Vitamins help to prevent further vascular diseases. Vitamins E and C should be mentioned here in particular. Carotenoids can also have a positive effect.

The patient should avoid the consumption of high fat or fried foods. Hydrogenated fats should disappear from the menu. The “stress” factor also plays an important role in the follow-up care for ischemia. This should be minimized as much as possible in the professional and private environment.

You can do that yourself

People with ischemia should seek medical care. In order to be able to determine suitable self-help measures, the causal illness must first be determined. Therefore, immediate medical evaluation is the most important action a person can take.

A slight ischemia can be cured relatively quickly with medication and rest. Even after an operation, bed rest and rest apply to those affected. If the pain persists, it is best to inform the doctor. In consultation with the doctor, natural means such as St. John's wort or belladonna can be used to reduce the symptoms. Massages, acupuncture and other alternative treatment methods are also allowed with the consent of the doctor.

After the disease has been cured, the lifestyle must be changed. Above all, measures that strengthen the cardiovascular system are important, for example exercise, a healthy and balanced diet and avoiding stimulants such as alcohol and nicotine. Ischemia patients should also avoid stress and get a restful night's sleep. At the same time, regular check-ups in the hospital are indicated because, depending on the underlying disease, ischemia can occur again and again.