Ischemic preconditioning involves cutting off blood supply to the heart tissue for short periods of time to prevent ischemic tissue damage during myocardial ischemic events. It is being tested to minimize risks during coronary artery bypass grafting and could potentially prevent damage to heart tissue in people at high risk of myocardial infarction. It could also be applied to other tissues such as the liver, brain, and kidneys.
Ischemic preconditioning is a process by which the blood supply to the myocardial tissue of the heart is cut off for a short period of time. After the disruption process, blood can reperfuse the tissues, meaning blood flow is restored. This is done a number of times. The ischemic preconditioning process is thought to help prevent ischemic tissue damage during myocardial ischemic events, such as a heart attack or myocardial surgery.
Myocardial infarction, or heart attack, is a leading cause of death worldwide. It can be caused by a number of mechanisms, including a buildup of plaque in the vessels, which can ultimately cause blockage of the vessels. This could, in turn, cause some heart tissue to die by cutting off the oxygen supply. This is called “ischemia” in medicine – the cutting of blood to an area.
Coronary artery bypass grafting (CABG) is a surgical procedure performed on patients who have cardiovascular disease, most commonly after a myocardial infarction. Basically, a piece of blood vessel from another part of the body is attached to the coronary vessel above and below the blocked area, which allows blood to flow past the blockage. It thus improves blood flow and oxygen supply to the heart. However, during CABG there is a risk that other heart tissue will become ischemic during the procedure.
Experimental medical treatments, such as ischemic preconditioning, are being tested by medical scientists to minimize this risk. Trials have been done using specific anesthetics to cut off the blood supply for a short time, causing ischemia and then allowing reperfusion. The process is repeated two or more times. The results of these studies demonstrated that the process could prevent further ischemic damage during surgery via a series of biochemical feedback mechanisms.
There is also speculation in the medical fraternity that ischemic preconditioning might be helpful in preventing damage to heart tissue. This would apply to people at high risk of myocardial infarction, such as those with angina. The timing of ischemic preconditioning, however, will be critical if it is shown to be a viable medical intervention.
Ischemic preconditioning could also apply to tissues other than those of the heart, although most of the work has been done on myocardial tissue. Other tissues that have been studied are those of the liver, brain and kidneys. Ischemic preconditioning of the kidney could help minimize acute renal failure in people at risk. Animal studies have demonstrated a protective effect of ischemic preconditioning.
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