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Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. [3] Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcpO2 ), or skin perfusion pressure (SPP).
Functional ischemia occurs when the blood flow is normal at rest but insufficient during exercise, presenting clinically as intermittent claudication. Critical ischemia is produced when the reduction in blood flow results in a perfusion deficit at rest and is defined by the presence of pain at rest or trophic lesions in the legs.
The signs and symptoms of ischemia vary, as they can occur anywhere in the body and depend on the degree to which blood flow is interrupted. [4] For example, clinical manifestations of acute limb ischemia (which can be summarized as the "six P's") include pain, pallor, pulseless, paresthesia, paralysis, and poikilothermia.
Symptoms may also include intermittent claudication or pain at rest. In late stages, paresthesia is replaced by anesthesia (numbness) due to death of nerve cells. [ 11 ] In severe cases, gangrene can occur suddenly and spread rapidly, [ 12 ] and should be treated within six hours of ischaemia.
Also known as 'effort angina', this refers to the classic type of angina related to myocardial ischemia.A typical presentation of stable angina is that of chest discomfort and associated symptoms precipitated by some activity (running, walking, etc.) with minimal or non-existent symptoms at rest or after administration of sublingual nitroglycerin. [11]
A common symptom is angina, which is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. [4] Occasionally it may feel like heartburn. In stable angina, symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. [4]
Ischemia, and resulting chest pain is due to coronary artery vasospasms, meaning the smooth muscles around the arteries constrict extremely tightly and reduce blood flow enough to cause ischemia. Episodes of vasospastic angina don’t correlate with exertion and can happen anytime, including at rest.
Chest pain due to coronary ischemia commonly radiates to the arm or neck. [7] Certain individuals such as women, diabetics, and the elderly may present with more varied symptoms. [ 8 ] If blood flow through the coronary arteries is stopped completely, cardiac muscle cells may die, known as a myocardial infarction, or heart attack.