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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).
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.
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.
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.
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.
Pain in the affected area [1] [2] Muscle spasm in the affected area [1] Numbness and tingling in an arm or leg [1] [2] Paleness [1] [2] of the skin of the arm or leg; Muscle weakness of an arm or leg, [1] [2] possibly to the grade of paralysis [2] Later symptoms are closely related to infarction of the tissue supplied by the occluded artery:
Levine's sign is a clenched fist held over the chest to describe ischemic chest pain. [1]It is named for Samuel A. Levine (1891–1966), an influential American cardiologist, who first observed that many patients with chest pain made this same sign to describe their symptoms.
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]