Under the definition of reperfusion syndrome, we understand the condition that occurs after the resumption of normal blood circulation in the area affected by ischemia. Doctors often have to deal with all kinds of manifestations of ischemia in practice. Reduced blood flow may be due to various reasons.
Such a violation can be short or long, it can cover a small area or affect a significant part of the body. This factor determines how successful the recovery will be.
In principle, reperfusion syndrome can be considered a peculiar response of the body to ischemia of any nature of origin. In medical circles, this condition is also called "inclusion." Nevertheless, the concept of reperfusion cardiac syndrome should be known to the patients themselves. For this, an article was prepared.
Reperfusion mechanism
In heart attacks, due to a violation of the capacity of blood vessels, there is a lack of supply of tissue of the heart muscle.
A similar phenomenon occurs with a stroke. As a rule, such violations are the result of stenosis or the result of the formation of a blood clot. When it is possible to expand the lumen of the artery, then the renewed blood supply is not always able to ensure the normal course of metabolic processes. On the contrary, the condition of the patient may deteriorate sharply, which is explained by the development of reperfusion syndrome. It is possible to get a patient out of such a grave condition only with the help of the immediately begun complex intensive care.
A similar clinic can be traced after removing the stitches if the patient underwent surgery. Compared with prolonged ischemia, a short-term (no more than 3 hours) or partial decrease in blood flow is not accompanied by serious consequences. In such cases, blood circulation usually quickly normalizes, and with it, the course of metabolic processes stabilizes.
Long-term ischemia is dangerous because products of improper metabolism accumulate during the violation, and when normal blood flow resumes, they are transferred to neighboring areas, causing tissue destruction there.
Clinic reperfusion
The symptomatology of the syndrome is not always the same, because the area affected by ischemia plays a key role. It is necessary to consider the features of the clinic, depending on this factor.
Myocardial ischemia
The severity of the clinical picture of reperfusion syndrome with myocardial infarction largely depends on the duration of ischemia. Experts are guided by the following indicators. If this period leaves up to 20 minutes, then reperfusion syndrome may be absent altogether.
But in a 40-minute state, when normal blood circulation is disturbed, often after the resumption of blood flow, as a result, damage to the heart muscle occurs. That is, the syndrome of ischemic and reperfusion damage to the myocardium is a dangerous condition.
Heart attacks
Myocardial conditions are characterized by the fact that certain symptoms are often noted at the stage of restoration of blood circulation. We list them:
- arrhythmia;
- signs of heart failure (heart failure) increase;
- blood pressure falls;
- the borders of the heart expand;
- there is a risk of aneurysm.
Brain injuries
Similar phenomena are often observed after traumatic brain injury (TBI). Against the background of relative stabilization of hemodynamics with timely initiation of therapy, the patient's condition may suddenly worsen. In this case, patients sharply increase signs of depression of consciousness.
Resuscitators, together with neurosurgeons, have long been searching for ways to prevent such secondary brain damage, but so far their aspirations have not been crowned with success.
Stroke
With a stroke of the ischemic type, the following symptoms are observed:
- reflexes are broken;
- consciousness is disturbed up to its complete loss;
- speech is getting worse;
- disorders of motor functions appear;
- signs of cerebral edema increase;
- there may be cramps.
If ischemia is aggravated by hemorrhage, the recovery period, even with intensive care, can take months, and often years.
Lerish's syndrome
This is a rare disease in which part of the aorta in the lower abdominal region loses bandwidth, has a bright clinic of the "inclusion" syndrome.
Despite the resumption of peripheral circulation, as evidenced by warmer limbs, patients complain of severe pain in the lumbar region. The picture is supplemented by a violation of the heart rhythm. Often, in such patients, signs of lung damage are rapidly increasing.
Restoring blood flow to the extremities
Reperfusion syndrome in this case is usually also accompanied by vivid symptoms. These phenomena are especially acute in a day after the initiation of treatment.
If we summarize the above information, we can conclude that the period of renewal of blood circulation in the area with severe tissue damage is usually accompanied by both local and general disorders. For example, with reperfusion of the brain, tissue swelling increases, and after surgery on the lower limb, the intensity of pain increases, and trophic disorders are observed.
Of the systemic manifestations of the "inclusion" syndrome, special attention should be paid to the development of multiple organ failure - this is the most severe severe reaction of the body. In most clinical cases, there is an increase in the symptoms of ARDS (respiratory distress syndrome), encephalopathy.
In other words, reperfusion syndrome develops where an episode of ischemia occurred. Moreover, the larger the lesion area and the longer the period of blood flow disturbance, the brighter the clinical symptoms will be expressed.
Causes of Reperfusion
In critical situations, when normal blood flow is disturbed, the tissues receive less oxygen, resulting in hypoxia.
The basis of the pathogenesis of the “inclusion” syndrome is the so-called “oxygen paradox”. Its essence lies in the fact that when normal blood circulation is established after temporary hypoxia, the manifestations caused by a lack of oxygen do not stop, but, on the contrary, manifest themselves most clearly. This is the peculiarity of this phenomenon. That is, with a sharp activation of oxidation processes, the mechanisms of formation of a large number of free radicals are triggered.
As a result of these processes, the integrity of the cell membranes is violated, which ultimately leads to massive destruction of the structure of damaged tissues.
The reasons for reducing the patency of the bloodstream are most often due to the formation of a blood clot, the appearance of atherosclerotic plaques on the walls, and spasm of the artery. All this leads to circulatory disorders in the main vessels and vessels of the brain, which is accompanied by symptoms characteristic of ischemia.
The restoration of blood flow in such cases may be due to the following factors:
- spontaneous relaxation of the walls of the vessel;
- the introduction of antispasmodic or analgesics;
- dissolution of a blood clot by enzymatic products;
- surgical removal of a blood clot;
- installation of a stent (special catheter);
- bypassing the lumen of the vessel (creating a bypass route for blood flow);
- spontaneous restoration of blood circulation after surgical removal of a blood clot or when redirecting blood flow along an alternative path.
As a result of the resumption of blood flow - in the tissues of the brain and heart muscle, separate zones arise that differ in the level of physiological activity and metabolic processes. Moreover, one part of such local zones still lacks the required blood volumes due to impaired patency of small vessels, and accelerated tissue destruction is observed in other areas.
In other words, after the resumption of blood circulation, tissue cells are simply not able, due to previous ischemia, to assimilate the previous volumes of oxygen, liquid, nutrients. For this reason, the development of an energy resource does not occur. As a result, swelling of the tissues increases, inflammatory processes develop.
Treatment methods
Therapy for the symptoms of reperfusion syndrome is carried out comprehensively. In this case, the doctor must take into account all the cornerstones that provoke the development of pathology, namely:
- active formation of free radicals;
- magnesium deficiency;
- excessive amounts of calcium salts;
- the development of arrhythmia (contributes to reperfusion syndrome with myocardial infarction);
- impaired energy synthesis.
Given the above factors, the following methods are included in the treatment complex.
Correction of electrolyte dysfunctions
To neutralize the destructive effect of calcium ions, antagonists are used: Norax, Diacordin, Isoptin.
In case of stroke, “Cinnarizine” is prescribed. These drugs relieve spasm and reduce the risk of platelet aggregation.
Antioxidant therapy
It is aimed at protecting the cellular structures of tissues. Quercetin is a highly effective drug. It reduces platelet activity, and eliminates blood flow asymmetry.
A positive result gives the use of such means as Kudesan, Mexidol.
Stimulation of metabolic processes
It is carried out through the use of medications:
- with a heart attack - "Trimetazidine";
- with a stroke - “Ceraxon”.
These drugs normalize the flow of electrolytes. They contribute to the formation of full-fledged energy bonds.
In addition, the drugs accelerate the course of recovery processes in ischemic tissue damaged.
Antiarrhythmic therapy
It is reduced to the use of such drugs as Lidocaine, Cordaron. Such medications reduce the risk of ventricular fibrillation with frequent attacks of tachycardia or the appearance of a series of extrasystoles.
If the therapy proves to be unproductive, defibrillation may be used. In order to normalize the course of metabolic processes in the heart muscle, Curantil and Magnesium Sulfate are prescribed.
General strengthening means
Usually also included in the treatment of reperfusion syndrome. They are necessary to restore the protective resources of the patient’s body, as well as to replenish the missing trace minerals to the tissues. As a rule, B vitamins, nicotinic acid (vitamin PP), and ascorbic acid are used.
Of course, rehabilitation therapy should be carried out exclusively in a hospital setting. The implementation of the entire complex of therapeutic measures is necessarily controlled by a doctor.
Prevention of Reperfusion Syndrome
As the saying goes, an ailment is easier to "strangle at the germ" than to heal later. Therefore, it is worth considering preventive measures. To exclude the development of reperfusion syndrome or to smooth out its negative manifestations, in modern practice, doctors use tools that:
- can completely exclude the formation of ROS (reactive oxygen species):
- provide oxygen directly to cellular structures;
- help restore the normal course of metabolism along the aerobic path;
- allow you to save tissue from repeated damage.
Applying effective preventive measures in practice, the destructive consequences of secondary tissue damage after severe head injury can be prevented. If we are talking about heart attacks, then, following certain measures, it is possible to prevent the appearance of arrhythmias, which often with inadequate therapy result in a fatal outcome.
Of course, we must not forget that much depends on the patient himself. After all, the origins of all critical, life-threatening conditions originate from everyday life. This is an unhealthy diet and bad habits, lack of sleep and an inactive lifestyle. It is these factors that are responsible for most cases of stroke and myocardial infarction.