ISCHEMIA

ISCHEMIA

1. What is ischemia? a condition in which blood flow and thus oxygen is restricted to a part of the body.

   • Sites where ischemia can occur: The brain= stroke , The eyes causing vision deficit which is a warning sign of reduced blood flow of the corroded artery, The heart which can cause angina The small and large intestine , ischemia to the bowel can cause a bowel obstruction and subsequent necrosis, In renal arteries and kidneys can cause acute renal failure , The legs and fingers , ischemia within the femoral artery can be related to peripheral arterial disease which can causes a loss of a limb, Following an injury or a broken bone could be related to compartment syndrome which needs to be treated urgently due to it leading to tissue death.

2. what can ischemia lead to? if ongoing and severe , cells can die without acess to normal blood flow which is known as infarction or necrosis,

   • • signs of ischemia
       • ineffective issue perfusion
       • dyspnea (shortness of breath)
       • profuse sweating/diaphoresis
         • look at intrevntions meantiioned in inflammation for hyperthermia
       • pulmonary flash oedema
         • Encourage changing of positions frequently to help keep fluid from pooling in the bases of the lungs, an ideal position is the prone position as it promotes lung perfusion
       • heart palpitations

3. factors which can cause ischemia? vasoconstriction, vasopasm, atheroscrelosis , anaemia, haemorrahage

   • what is atherscrerosis? • atherosclerosis is the thickening of an artery wall due to the accumulation of fatty substances • Such as cholesterol and lipids which we call plaque deposits which causes narrowing of the artery , • atherosclerosis is the usual cause of cardiac arrests stroke and PVD.
     • Diagnostic test to confirm atherosclerosis: CXR ,Stress tests ,Angiography ,Cardiac troponin levels – these proteins are released when the heart has been damged • ECG- assists diagnosis when a patient comes in with chest pain , cardiac arrest Help identify the areas of ischemia , they are performed in conjunction to other diagnostic methods.

4. what is acute coronary syndrome? is a term used to describe a range of conditions associated with sudden , reduced blood flow to a part of the myocardium. acute coronary syndrome is a subcategory of coronary artery disease

   • What does acute coronary syndrome include? ACS includes… • unstable angina • non–ST-segment elevation (non–Q-wave) myocardial infarction • ST-segment elevation (Q-wave) myocardial infarction.
     • STEMI VS NSTEMI: STEMI or ST-elevation myocardial infarction is caused by a sudden complete (100 percent) blockage of a heart artery (coronary artery). • A non-STEMI is usually caused by a severely narrowed artery but the artery is usually not completely blocked.
     • NSTEMI
     • STEMI
       • TYPE 1: Spontaneous Myocardial Infarction
         • PLAQUE RUPTURE
       • TYPE 2:myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply
         • O2 DEMAND-SUPPLY IMBALANCE
       • LEAD TO
         • HYPOXIA
           • DYSPONEA
         • DECREASED SNS OUTFLOW
           • SENSES OF IMPENDING DOOM
           • ANXIETY
           • INCREASED HEART RATE
           • PALLOR
           • DIAPHORESIS
         • DECREASED ATP
           • INFLAMMATORY MEDIATORS RELEASED
             • SYMPATHETIC AFFERENT TRANSMISSION
               • CHEST PAIN
           • ACIDOSIS
             • NAUSEA
             • DYSRYTHMIA
         • MYOCARDIAL NECROSIS
           • HYPOTENSION
             • monitoring with BP and ECG + symptom support for example adminstering antiarrhythmic meds
         • HYPERCOAGUBLE STATE
           • REVASCULARISATION
             • BYPASS GRAFTS
               • ANGIOPLASTY
                 • STENT
                   • THROMBOLYTIC
     • ACS CAUSES DECREASED MYOCARDIAL PERFUSION
       • CAUSES ISCHAEMIA
         • UNSTABLE ANGINA PECTRORIS
   • What are the risk factors for ACS? • Atherscrolisis • Aging. • High blood pressure. • High blood cholesterol. • Cigarette smoking. • Lack of physical activity. • Unhealthy diet. • Obesity or overweight. • Diabetes.
   • Electrocardiographic Changes with ACS: • T-wave inversion, • ST-segment elevation • development of an abnormal Q wave.

5. what is peripheral arterial disease or vascular disease? The hallmark of peripheral vascular disease (PVD) is the disruption of peripheral perfusion due to an obstruction of the blood vessels and increased thrombogenesis. The primary feature of peripheral arterial disease (PAD) is reduced perfusion in the peripheral tissues , leading to ischaemia and potential tissue necrosis

   • What are the causes of Peripheral Arterial Disease (PAD)? - Peripheral arterial disease is overwhelmingly associated with atherosclerosis and diabetes, but also may be associated with vasospasm, venous insufficiency, embolism, vasculitis, fibromuscular dysplasia and entrapment
     • How it occurs due to atherscrolosis: Atherosclerosis is a systemic disease. It is the formation of lipid deposits in the tunica media and associated with damage to the endothelial lining [9].The endothelial cells become swollen with lipids and create a gap between in the linings. Platelets stick to the exposed collagen fibers, forming a localized clot that restricts arterial blood flow, leading to inadequate tissue perfusion. This and other complex interactions can lead to progression from asymptomatic PAD, Intermittent Claudication, Critical Limb Ischemia, Acute Limb Ischemia
       • thrombosis may become an Emboli which results in ischemia causing
         • PAIN
         • PULSELESSNESS
         • PALLOR
         • PARALYSIS
         • PARAESTHESIAS
         • INFARCTION
         • anticoagulants, intra-arterial thrombolysis, embolectmy , amputation,
       • Problems are the same as mentioned for ischemia

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