Also Known As
Ischaemia, hypoperfusion, impaired perfusion, inadequate perfusion, reduced circulation, decreased blood flow, local anemia.
Definition
Ischemia is defined as an inadequate blood supply (circulation) to a local area of the body due to blockage or constriction of the blood vessels supplying that area. This reduction in blood flow means that the affected tissue or organ does not receive enough oxygen and nutrients to function properly and can lead to tissue damage or dysfunction if prolonged.¹
Clinical Context
Ischemia is a critical clinical concern as it can affect any organ or tissue in the body, leading to a wide range of medical conditions depending on the location and severity of the blood flow restriction. Clinically, ischemia is suspected when a patient presents with symptoms indicative of organ dysfunction or pain that could be related to reduced blood flow. For example, in the heart, ischemia can manifest as angina (chest pain) or a myocardial infarction (heart attack) and is a hallmark of coronary heart disease (CHD).¹ In the brain, ischemia can lead to a transient ischemic attack (TIA) or a stroke. Peripheral artery disease (PAD) is another common condition where ischemia affects the limbs, typically the legs, causing pain and, in severe cases, tissue loss.¹
Relevant medical conditions associated with ischemia are numerous and include, but are not limited to: coronary artery disease, stroke, peripheral artery disease, mesenteric ischemia (affecting the intestines), renal ischemia (affecting the kidneys), and critical limb ischemia.¹
Diagnosis of ischemia often involves a combination of clinical assessment, imaging studies, and functional tests. For instance, in suspected cardiac ischemia, an electrocardiogram (ECG), stress tests (exercise or pharmacological), echocardiography, and coronary angiography may be used to identify and assess the extent of reduced blood flow.¹ For peripheral ischemia, ankle-brachial index (ABI) measurements, Doppler ultrasound, and angiography are common diagnostic tools. The specific diagnostic approach depends heavily on the affected organ system.¹
Patient selection for interventions to treat ischemia depends on the underlying cause, the severity of the ischemia, and the patient’s overall health. Interventions can range from lifestyle modifications and medical management (e.g., antiplatelet drugs, statins, vasodilators) to more invasive procedures such as angioplasty, stenting, or bypass surgery to restore blood flow.¹
Expected outcomes vary widely. If blood flow is restored promptly, tissue damage can be minimized, and function may be preserved or recovered. However, prolonged or severe ischemia can lead to irreversible tissue death (infarction), organ failure, and significant morbidity or mortality. Early diagnosis and appropriate management are crucial for improving outcomes in patients with ischemic conditions.¹