Ischemia
In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia.
Mechanism
Rather than in hypoxia, a more general term denoting a shortage of oxygen (usually a result of lack of oxygen in the air being breathed), ischemia is an absolute or relative shortage of the blood supply to an organ. Relative shortage means the mismatch of blood supply (oxygen delivery) and blood request for adequate oxygenation of tissue.
Ischemia can also be described as an inadequate flow of blood to a part of the body, caused by constriction or blockage of the blood vessels supplying it. Ischemia of heart muscle produces angina pectoris.
This can be due to:
- Tachycardia (abnormally rapid beating of the heart)
- Atherosclerosis (lipid-laden placques obstructing the lumen of arteries)
- Hypotension (low blood pressure, e.g. in septic shock, heart failure)
- Thromboembolism (blood clots)
- Outside compression of a blood vessel, e.g. by a tumor
- Foreign bodies in the circulation (e.g. amniotic fluid in amniotic fluid embolism)
- Sickle cell disease (abnormally shaped hemoglobin)
Consequences
Since oxygen is mainly bound to hemoglobin in red blood cells, insufficient blood supply causes tissue to become hypoxic, or, if no oxygen is supplied at all, anoxic. This can cause necrosis (i.e. cell death). Necrosis due to ischemia usually takes about 10-12 hours.
Ischemia is a feature of heart diseases, transient ischemic attacks, cerebrovascular accidents, ruptured arteriovenous malformations, and peripheral artery occlusive disease.
Tissues especially sensitive to inadequate blood supply are the heart, the kidneys, and the brain. Ischemia in brain tissue, for example due to stroke or head injury, causes a process called the ischemic cascade to be unleashed, in which proteolytic enzymes, reactive oxygen species, and other harmful chemicals damage and may ultimately kill brain tissue.
Restoration of blood flow after a period of ischemia can actually be more damaging than the ischemia. Reintroduction of oxygen causes a greater production of damaging free radicals, resulting in reperfusion injury. With reperfusion injury, necrosis can be greatly accelerated.
Detection
Initial evaluation of chest-pain patients involves a 12 lead electrocardiogram (ECG) and cardiac markers such as Troponins. These tests are highly specific but very insensitive and often leave the requirement for further testing to achieve an accurate diagnosis. Magnetocardiography (MCG) imaging utilises usperconducting quantum interference devices (SQUIDs) to detect the weak magnetic fields generated by the heart;s electrical fields.[1]. There is a direct correlation between abnormal cardiac depolarisation or repolarisation and abnormality in the magnetic field map. In July 2004, the Food and Drug Administration (FDA) approved the CardioMag Imaging MCG as a safe device for the non-invasive detection of ischemia.
References
Notes
- Oxford Reference: Concise Medical Dictionary (1990, 3rd ed.). Oxford University Press: Market House Books.