Ischaemia

Ischaemia is when part of your body gets less blood flow than it needs, so the tissue doesn't get enough oxygen. It can affect almost any part of the body, including your heart, brain, legs or digestive system, and ranges from a mild, temporary problem to a medical emergency.

Symptoms of ischaemia

Symptoms depend on which part of your body is affected.

If it affects your heart, you may have:

• chest pain or discomfort (angina)
• pain spreading to your upper body
• shortness of breath
• sweating
• indigestion-like discomfort
• nausea or vomiting
• dizziness or lightheadedness
• a fast or irregular heartbeat.

If it affects your legs or feet, you may have:

• cold, pale, numb or burning feet
• loss of hair on your toes, feet or legs
• discoloured patches of skin
• cramping pain in your calf, thigh or bottom when walking or at night
• slow-healing wounds that can become infected
• fragile skin that bruises or tears easily.

If it affects your brain, symptoms come on suddenly and can be remembered with the word FAST:

• Face drooping on one side
• Arm weakness
• Speech difficulty
• Time to call 999.

If it affects your digestive system, you may have severe abdominal pain, bloating, diarrhoea or feeling sick.

Sometimes ischaemia causes no symptoms at all, known as silent ischaemia, particularly in people with diabetes.

Causes of ischaemia and who is at risk

Ischaemia happens when something blocks or narrows the blood vessels supplying an area of your body. Common causes include:

• atherosclerosis, where fatty deposits build up and narrow your arteries
• a blood clot blocking a blood vessel
• very low blood pressure
• inflammation of the blood vessels (vasculitis)
• a strangulated hernia, which can cut off blood supply to trapped tissue.

You may be more likely to develop ischaemia if you:

• smoke
• have high blood pressure, high cholesterol or diabetes
• are overweight or not very physically active
• have an irregular heartbeat, such as atrial fibrillation
• drink alcohol excessively
• have chronic kidney disease or a blood clotting disorder
• have already had a heart attack, stroke, or ischaemia elsewhere in your body
• are aged 55 or over.

Are there different types of ischaemia?

Ischaemia is named after the part of the body it affects:

• Myocardial ischaemia: This affects the heart muscle
• Ischaemic stroke: This is a sudden, lasting loss of blood flow to the brain
• Transient ischaemic attack (TIA): This is a temporary version of a stroke where symptoms fully resolve within 24 hours
• Mesenteric ischaemia: This affects the digestive system
• Peripheral or limb ischaemia: This affects the arms or legs.

As mentioned, silent ischaemia is when reduced blood flow to the heart causes no obvious symptoms, and is more common in people with diabetes or a previous heart attack.

How ischaemia is diagnosed

A doctor will ask about your symptoms and medical history and examine the affected area. They may check your blood pressure and arrange blood tests to look at your cholesterol, blood sugar, or signs of heart damage.

Further tests depend on which part of your body is affected, but can include an electrocardiogram (ECG) to check your heart's electrical activity, an echocardiogram or Doppler ultrasound to look at blood flow, an exercise stress test, an angiogram, or scans such as an MRI, CT or PET scan.

How ischaemia is treated

Treatment aims to restore blood flow and depends on the cause, location and severity of your ischaemia.

Healthy lifestyle changes are recommended for almost everyone, including regular physical activity, reaching a healthy weight, eating a nutritious diet, and stopping smoking.

Medication is often used to treat the underlying cause and reduce your risk of further problems. This can include medicines to lower blood pressure or cholesterol, blood thinners such as anticoagulants or antiplatelets, clot-busting medication, or antibiotics if there's an infection.

If blood flow needs to be restored more directly, a doctor may recommend a procedure or surgery, such as angioplasty and stenting to open a narrowed artery, a bypass to reroute blood flow around a blockage, or surgery to remove a blood clot or damaged tissue.

When to see a doctor

Call 999 immediately if you or someone else has sudden symptoms of a stroke (FAST) or a heart attack, such as chest pain that doesn't go away, or severe, sudden abdominal pain.

See a GP urgently if:

• you've had symptoms that sound like a TIA, even if they've since passed
• you have ongoing pain, numbness or colour changes in your leg or foot
• you notice a wound on your foot or leg that isn't healing.

If you have any injury to your foot, however minor, get it checked by a healthcare professional, as poor circulation can make even small wounds serious.