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Ischemia
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==Signs and symptoms== 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.<ref name="auto"/> For example, clinical manifestations of [[Acute limb ischaemia|acute limb ischemia]] (which can be summarized as the '''"six Ps"''') include [[pain]], [[pallor]], [[pulseless]], [[paresthesia]], [[paralysis]], and [[Poikilotherm#In medicine|poikilothermia]].<ref>{{Citation|last1=Smith|first1=David A.|title=Acute Arterial Occlusion|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK441851/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=28722881|access-date=2021-10-27|last2=Lilie|first2=Craig J.}}</ref> Without immediate intervention, ischemia may progress quickly to tissue [[necrosis]] and [[gangrene]] within a few hours. [[Paralysis]] is a very late sign of acute arterial ischemia and signals the death of [[nerves]] supplying the extremity. [[Foot drop]] may occur as a result of [[nerve damage]]. Because nerves are extremely sensitive to [[hypoxia (medical)|hypoxia]], limb [[paralysis]] or ischemic [[neuropathy]] may persist after [[revascularization]] and may be permanent.<ref name=Lewis/> === Cardiac ischemia === {{main|Coronary ischemia|Coronary artery disease}} Cardiac ischemia may be asymptomatic or may cause chest pain, known as [[angina pectoris]]. It occurs when the heart muscle, or [[myocardium]], receives insufficient blood flow.<ref>{{Cite web|title=Myocardial ischemia - Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/symptoms-causes/syc-20375417|access-date=2021-10-27|website=Mayo Clinic|language=en}}</ref> This most frequently results from [[atherosclerosis]], which is the long-term accumulation of cholesterol-rich plaques in the [[coronary arteries]]. In most Western countries, [[Coronary artery disease|ischemic heart disease]] is the most common cause of death in both men and women, and a major cause of hospital admissions.<ref name=WHO>{{cite book |author= World Health Organization Department of Health Statistics and Informatics in the Information, Evidence and Research Cluster |title=The global burden of disease 2004 update |publisher=WHO |location=Geneva |year=2004 |isbn=92-4-156371-0}}</ref><ref>{{Cite web|title=Coronary Artery Disease|url=https://medlineplus.gov/coronaryarterydisease.html|access-date=2021-10-27|website=medlineplus.gov}}</ref> === Bowel === {{Main|Intestinal ischemia}} Both large and small intestines can be affected by ischemia. The blockage of blood flow to the [[large intestine]] (colon) is called [[ischemic colitis]].<ref>{{Cite web|title=Ischemic colitis - Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/ischemic-colitis/symptoms-causes/syc-20374001|access-date=2021-10-27|website=Mayo Clinic|language=en}}</ref> Ischemia of the [[Small intestine|small bowel]] is called [[mesenteric ischemia]].<ref>{{Cite web|title=Acute Mesenteric Ischemia - Digestive Disorders|url=https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/acute-mesenteric-ischemia|access-date=2021-10-27|website=Merck Manuals Consumer Version|language=en-US}}</ref> === Brain === {{Main|Brain ischemia|Ischemic stroke}} [[Brain ischemia]] is insufficient blood flow to the [[brain]], and can be [[acute (medicine)|acute]] or [[chronic condition|chronic]]. Acute [[ischemic stroke]] is a neurological emergency typically caused by a blood clot blocking blood flow in a vessel in the brain.<ref>{{Cite web|title=Ischemic Stroke|url=https://medlineplus.gov/ischemicstroke.html|access-date=2021-10-27|website=medlineplus.gov}}</ref> Chronic ischemia of the brain may result in a form of [[dementia]] called [[vascular dementia]].<ref>{{cite journal|last1=Kuźma|first1=Elżbieta|last2=Lourida|first2=Ilianna|last3=Moore|first3=Sarah F.|last4=Levine|first4=Deborah A.|last5=Ukoumunne|first5=Obioha C.|last6=Llewellyn|first6=David J.|date=August 2018|title=Stroke and dementia risk: A systematic review and meta-analysis|url=https://www.alzheimersanddementia.com/article/S1552-5260(18)33250-3/abstract|journal=Alzheimer's & Dementia|volume=14|language=en|issue=11|pages=1416–1426|doi=10.1016/j.jalz.2018.06.3061|pmid=30177276|issn=1552-5260|pmc=6231970|hdl=2027.42/152961|access-date=2018-09-07|archive-date=2021-08-28|archive-url=https://web.archive.org/web/20210828131059/https://alz-journals.onlinelibrary.wiley.com/journal/15525279|url-status=dead}}</ref> A sudden, brief episode (symptoms lasting only minutes) of ischemia affecting the brain is called a [[transient ischemic attack]] (TIA), often called a mini-stroke.<ref name="auto1">{{Cite web|title=Transient Ischemic Attack|url=https://medlineplus.gov/transientischemicattack.html|access-date=2021-10-27|website=medlineplus.gov}}</ref> TIAs can be a warning of future strokes, with approximately 1/3 of TIA patients having a serious stroke within one year.<ref name="auto1"/><ref>{{Cite web|title=What is a TIA|url=https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack/what-is-a-tia|access-date=2021-10-27|website=www.stroke.org|language=en}}</ref> === Limb === {{main|Acute limb ischaemia|Chronic limb threatening ischemia}} Inadequate blood supply to a [[Limb (anatomy)|limb]] may result in [[Acute limb ischaemia|acute limb ischemia]] or [[chronic limb threatening ischemia]]. === Cutaneous === {{See also|Cyanosis|Gangrene}} Reduced blood flow to the skin layers may result in [[mottling]] or uneven, patchy discoloration of the skin. === Kidney ischemia === [[Kidney ischemia]] is a loss of blood flow to the kidney cells. Several physical symptoms include shrinkage of one or both kidneys,<ref name=":0">{{cite journal|url=https://journals.lww.com/jhypertension/abstract/1997/15120/ischemic_renal_disease__an_emerging_cause_of.1.aspx|author-last1=Preston|author-first1=Richard A. |author-last2=Epstein|author-first2=Murray|title=Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease|journal=Journal of Hypertension|volume=15|number=12|pages=1365-1377|date=December 1997|access-date=2020-12-20}}</ref> [[renovascular hypertension]],<ref>{{Cite web|title=Renovascular hypertension: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/000204.htm|access-date=2020-12-20|website=medlineplus.gov|language=en}}</ref> [[Acute kidney injury|acute renal failure]],<ref name=":0" /> progressive azotemia,<ref name=":0" /> and acute [[pulmonary edema]].<ref name=":0" /> It is a disease with high mortality rate and high morbidity.<ref>{{Cite journal|last1=Sharfuddin|first1=Asif A.|last2=Molitoris|first2=Bruce A.|date=April 2011|title=Pathophysiology of ischemic acute kidney injury|url=https://www.nature.com/articles/nrneph.2011.16|journal=Nature Reviews Nephrology|language=en|volume=7|issue=4|pages=189–200|doi=10.1038/nrneph.2011.16|pmid=21364518|s2cid=32234965|issn=1759-507X|url-access=subscription}}</ref> Failure to treat could cause [[chronic kidney disease]]<ref>{{Cite journal|last1=Zuk|first1=Anna|last2=Bonventre|first2=Joseph V.|date=2016-01-14|title=Acute Kidney Injury|journal=Annual Review of Medicine|volume=67|issue=1|pages=293–307|doi=10.1146/annurev-med-050214-013407|issn=0066-4219|pmc=4845743|pmid=26768243}}</ref> and a need for renal surgery.<ref>{{Cite journal|last1=Munshi|first1=Raj|last2=Hsu|first2=Christine|last3=Himmelfarb|first3=Jonathan|date=2011-02-02|title=Advances in understanding ischemic acute kidney injury|url= |journal=BMC Medicine|volume=9|issue=1|pages=11|doi=10.1186/1741-7015-9-11|issn=1741-7015|pmc=3038966|pmid=21288330 |doi-access=free }}</ref>
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