Myocardial infarction or stroke, ischemia is one of the leading causes of death in the world, and the second in France (the first for women) just after cancer. But how can they be treated and avoided?

For Muriel Bigot, a cardiologist, “ischemia is a defect in the arterial irrigation of an organ. The blood, which carries oxygen, no longer circulates because the artery is clogged, resulting in the death of the cells of the affected organ ”.

The different ischemias

Myocardial infarctions are ischemias that occur in the heart. Strokes, or strokes, occur in the brain when an artery becomes blocked. There are different types of ischemia depending on how quickly the artery is blocked.

Strictures

Stenosis “is a narrowing of the arteries, mainly linked to the appearance of atheromatous plaques. Blood circulation is reduced and cells receive less oxygen ”explains the cardiologist.

Atheroma

Atheroma is characterized by fatty plaques that form along the arteries. “Thrombosis, on the other hand, causes ischemia suddenly, by complete obstruction of the artery. It is often linked to the complication of a stenosis by a clot ”.

“It is possible to realize the narrowing of these arteries: with regard to the arteries of the heart, we feel pain in the chest. Symptoms vary depending on the territory concerned:

• heart,
• brain,
• muscles.

For example, if a stenosis occurs in a leg artery, the patient will experience pain when walking because the cells suffer from a lack of oxygen. On the other hand, for stroke, there are very few warning signs ”according to Muriel Bigot.

Symptoms that should alert

In case of stroke

However, when a stroke occurs, there are significant symptoms which should alert:

• paralysis on one side of the body
• a loss of balance,
• difficulty speaking, for example.

In case of myocardial infarction

In the case of a myocardial infarction, the characteristic symptoms are chest pain which can radiate to the shoulder and neck continuously. “In women, the symptoms can be atypical: pain that does not pass between the navel and the chin, in the stomach, nausea, vomiting…” specifies the cardiologist.

There are cardiovascular risk factors which depend on biology and on which it is impossible to act:

• genetic,
• aging,
• or the fact of being a man.

“We observe a protective effect for women before menopause thanks to sex hormones. Then this difference fades. Today cardiovascular disease is the leading cause of death in women. ” adds Muriel Bigot.

Lifestyle risk factors

Lifestyle also plays a major role in the causes of ischemia. Here are the ones that have a big influence on the risk of ischemia:

• The tobacco,
• cholesterol,
• lack of physical activity,
• physical inactivity,
• diabetes,
• high blood pressure,
• overweight
• or even food.

To screen for ischemia, it is possible to perform a Doppler examination, an ultrasound, an arteriography or an electrocardiogram with more or less urgency depending on the situation.

According to the Ministry of Solidarity and Health, “it is possible to estimate a level of cardio-neurovascular risk for each individual. People with a family history of cardiovascular disease, or with cardiovascular disease, kidney failure, diabetes, or atrial fibrillation (also called atrial fibrillation, it is characterized by an irregular heart rate and often very fast) untreated are considered a priori as high risk ”. If you are part of this at-risk population, do not hesitate to consult your doctor.

When ischemia is temporary or quickly taken care of, the sequelae may be mild or even non-existent. On the other hand, if the ischemia is treated later and blood circulation is not restored within a few hours of the artery being blocked, the sequelae are significant, even irreversible.

Heart attacks and strokes treated too late can lead to disabilities such as paralysis, speech disorders for strokes and heart failure or heart rhythm disturbances for the stroke. If ischemia occurs in other organs, their function will be impaired. And in the case of a blocked artery on a limb, the consequences can go as far as necrosis of said limb and its amputation.

In the event of thrombosis, or when a large artery suddenly becomes blocked, doctors have about six hours to treat the ischemia. Beyond this limit, the risk of irreversible injury increases considerably. “It’s a speed race. The faster the arteries are unblocked, the less sequelae there will be ”states the cardiologist. When the arteries gradually become blocked, as with stenosis, other arteries can grow around to compensate. 

How to treat ischemia?

But how to treat ischemia? The SAMU staff places an intravenous line on the patient through which a drug will flow that will dissolve the clot while awaiting arrival at the hospital: this is pre-hospital thrombolysis.

The goal: to restore blood circulation as quickly as possible. If the hospital is close, we will immediately resort to angioplasty to place a stent that will keep the artery open. Secondly, it is also possible to operate to bypass a blocked or stenosed artery. “After ischemia, patients stay on treatment all their lives to avoid recurrence,” remarks Muriel Bigot.

Some of the main risk factors for cardiovascular disease, including ischemia, are lifestyle related. It is therefore possible through simple means to reduce these factors such as smoking, an unbalanced diet, a lack of physical activity, psychosocial factors such as stress.

It is advisable to practice at least 30 minutes of physical activity per day (walking is one of them), to limit sugar, fat, salt and to avoid tobacco and alcohol. Certain diseases such as diabetes and high blood pressure can also promote myocardial infarction or stroke, they must be treated for life, and monitored regularly. By applying these recommendations, it would be possible to prevent a large part of cardiovascular disease.

“If you have warning symptoms that do not go away, such as paralysis or chest pain, you must call 15 (SAMU) urgently. If you have temporary symptoms, you should consult your doctor who will refer you to a neurologist or a cardiologist ”advises Muriel Bigot.