Ischemia

What is ischemia?

Ischemia means you have less blood flow than you should to an area of your body. Because blood carries oxygen to your cells and tissues, you get less oxygen when you have ischemia. This is the real issue, as your cells need oxygen to survive.

Often, a narrow artery or an artery with a blockage causes ischemia.

You can have a mild case of ischemia that isn’t causing issues yet, but it can get worse over time. A severe case can be life-threatening if enough cells die.

Types of ischemia

Types of ischemia include:

• Myocardial ischemia (heart muscle).
• Mesenteric ischemia (digestive system).
• Peripheral or limb ischemia (arm or leg).
• Ischemic stroke (brain).
• Transient ischemic attack or TIA (brain).

How common is ischemia?

Ischemia is very common. Heart disease is the top cause of death in the United States. A stroke (most of which are ischemic) happens every 40 seconds in America.

More than 200 million people in the world have peripheral artery disease (PAD). Out of those who have PAD, 11% have chronic limb-threatening ischemia.

Ischemia in your digestive system is rare. It more often arises in critically ill people in the intensive care unit (ICU).

What are the symptoms?

Ischemia symptoms vary depending on which area of your body needs more blood flow.

Symptoms of ischemia may include:

• Angina (chest pain).
• Shortness of breath.
• Lightheadedness or dizziness.
• Difficulty speaking.
• Loss of coordination.
• Pain in your leg or arm.
• Pale or cold leg or arm.
• Paresthesia (tingling or numbness) in your leg or arm.
• Severe pain in your belly (abdomen).
• Severe bloating in your belly.
• Diarrhea.
• Upset stomach.

What causes ischemia?

Ischemia happens because something is keeping blood from reaching the tissues the blocked artery supplies. “Global ischemia” can also happen if your entire body is exposed to low blood pressure or low oxygen levels for a prolonged period.

Ischemia causes include:

• Atherosclerosis.
• Blood clots.
• Abdominal hernia that becomes “strangulated.”
• Very low blood pressure.
• Vasculitis.
• Medical equipment (for procedures or life support) that a provider inserts into your arteries.

What are the risk factors for ischemia?

Risk factors for ischemia include:

• Having ischemia in another part of your body.
• High or low blood pressure.
• High cholesterol.
• Diabetes.
• Lack of physical activity.
• Obesity.
• Chronic kidney disease (CKD).
• Use of tobacco products.
• History of a heart attack.
• History of a stroke.
• Sleep apnea.
• Blood clotting disorders.
• Certain medicines, like birth control pills.

What are the complications of ischemia?

Ischemia can lead to:

• Heart attack.
• Critical limb ischemia.
• Stroke.
• Transient ischemic attack (TIA).
• Perforation of your small intestine.
• Gangrene, including infections.

How is ischemia diagnosed?

A healthcare provider will talk with you about your current symptoms and the conditions you’ve had in the past. They’ll do a physical exam that includes checking the area where you’re having an issue. They may order tests to help them make a diagnosis.

What tests will be done to diagnose ischemia?

Tests to diagnose ischemia may include:

• Blood tests.
• Ankle-brachial index test.
• Doppler ultrasound.
• Echocardiogram.
• Angiogram.
• MRI (magnetic resonance imaging).
• Computed tomography (CT).
• Exercise stress test.
• Electrocardiogram (EKG).
• PET scan (positron emission tomography scan).

How is ischemia treated?

Ischemia treatment increases the amount of blood flow to the area that isn’t getting enough oxygen. Treatments include medicines, lifestyle changes and procedures.

Medicines for ischemia include:

• Blood pressure-lowering medicine.
• Cholesterol-lowering medicine.
• Anticoagulants (blood thinners).
• Antiplatelets.
• Thrombolytics (clot-busting drugs).
• Antibiotics for infections.

Changes to your daily habits may include:

• Getting physical activity for at least 30 minutes five times a week.
• Staying at a weight that’s healthy for you.
• Avoiding tobacco products.
• Eating more nutritious foods, like more fruits and vegetables.

A provider may perform open or minimally invasive surgery to treat ischemia. Procedures may include:

• Angioplasty and stenting.
• Thrombectomy.
• Peripheral artery bypass surgery.
• Atherectomy.
• Coronary artery bypass graft (CABG).
• Endarterectomy.
• Laparoscopic surgery.
• Laparotomy.

How can I lower my risk of ischemia?

To lower your risk of ischemia, you can:

• Eat nutritious foods, like fruits, vegetables and whole grains.
• Drink enough fluids to avoid dehydration.
• Avoid tobacco products.
• Get regular physical activity.
• Manage conditions that can cause ischemia, like diabetes, high blood pressure and high cholesterol.

What can I expect if I have ischemia?

Any type of ischemia is a threat to your health because your cells aren’t getting the oxygen they need. Every case is different, but quicker treatment generally leads to a better outcome. For example, prompt open surgery has a 93% success rate for saving people’s ischemic limbs. But that rate drops to 78% when providers do the surgery eight hours after ischemia starts.

And when you’re talking about your brain or your heart, immediate treatment for these vital organs is crucial. Minutes can mean the difference between whether you survive or not. And it can determine how much damage ischemia causes and how much it affects your quality of life.

How do I take care of myself?

Taking care of yourself includes taking medicines your provider prescribed. Keep taking them without skipping a day. If you have trouble remembering to take medicine, set an alarm on your phone. You can also buy a pill organizer with spaces for each day’s medicines.

No matter which type of ischemia you have, you can care for yourself by changing daily habits and managing conditions that can lead to ischemia.

When should I see my healthcare provider?

Be sure to keep your follow-up appointments with your provider. They’ll want to know about any issues that don’t go away or that keep coming back. You should also tell them if you’re having bad side effects from your medicines. If you had a procedure or surgery, you’ll need follow-ups to see how your healing is going.

When should I go to the ER?

Get immediate medical attention if you have:

• Pain in your belly (abdomen) that comes on quickly or is severe.
• Symptoms of another heart attack or stroke.
• Bad pain in your leg or foot.

What questions should I ask my doctor?

Questions to consider asking your healthcare provider may include:

• How long will I need to take the medicines you prescribed?
• What’s my risk of another type of ischemia?
• Are my children and other family members at a higher risk now because of my diagnosis?
• How often do I need appointments with you?

A note from Cleveland Clinic

If you’ve been through a medical emergency related to ischemia, you may be wondering what’s next. Your healthcare provider can guide you through the next steps in your treatment. But you also need to think about what may change in your daily routines — even if it’s only for a short time. Now is the time to rally your friends and family around you. They may want to help but don’t know how. Ask them to pick up groceries or help with other household tasks while you recover. Others may be great at easing your fears or making you laugh. Support from other people can be that boost you need to make good progress in your healing.