Limb muscle infarction - arm or leg tissue infarction . This can lead to skeletal muscle infarction, aseptic necrosis of the bones, or necrosis of part or the entire limb.
Content
Affected Tissues
The tissues of nerves and muscles are mainly affected, where irreversible damage begins to occur 4-6 hours after the cessation of blood supply [1] .
Skeletal muscles are relatively more resistant to heart attack compared to the muscles of the heart and brain , since they can rely on anaerobic metabolism due to glycogen stored in the cells, which can provide muscle tissue with the ability to dissolve any clot, including a blood clot . In contrast, the tissues of the brain ( cerebral infarction ) and heart ( myocardial infarction ) do not store glycogen , as they specialize in aerobic metabolism, and lactate will not provide sufficient energy for their needs [2] .
Bones are more susceptible to ischemia , hematopoietic cells usually die within 12 hours, other bone cells ( osteocytes , osteoclasts , osteoblasts , etc.) within 12–48 hours [3] . On the other hand, bone has the best regenerative ability only in restoring blood supply, and the remaining dead inorganic bone tissue forms the basis on which new cells can restore bone functionality under optimal conditions [3] .
Reasons
- Thrombosis (approximately 40% of cases [4] )
- Arterial embolism (approximately 40% of cases [4] )
- Atherosclerosis obliterans [5]
Another cause of limb infarction is skeletal muscle infarction as a rare complication of diabetes [6] .
Symptoms
The early symptoms of arterial embolism in the arms or legs appear at the very beginning of the development of tissue ischemia, even before the onset of muscle infarction. Such symptoms may include:
- Cold in the leg, arm, or fingers [7] [8]
- Change in heart rate in the arm or leg outside the blockage [7] [8]
- Pain in the affected area [7] [8]
- Muscle spasm in the affected area [7]
- Numbness and tingling in the arm or leg [7] [8]
- Pallor [7] [8] of the skin of the hands or feet
- Muscle weakness of the arm or leg [7] [8] , possible paralysis [8]
More recent symptoms are closely related to tissue infarction, which appears due to blockage of the artery:
- Skin blisters in the affected area [7]
- Skin peeling [7]
- Skin erosion (ulcers) [7]
- Discoloration (speckles [8] , cyanosis [8] or darkening [7] ) of the skin as a result of necrosis . Color change, as a rule, has a pronounced demarcation at the site of blockage [8]
One of the main symptoms of skeletal muscle infarction due to diabetes is a painful swelling of the hip or leg [6] .
Diagnosis
In addition to assessing the symptoms described above, angiography can also distinguish between symptoms caused by obliterating atherosclerosis and those caused by embolism [5] .
Magnetic resonance imaging (MRI) is the preferred test for the diagnosis of skeletal muscle infarction [6] .
Treatment
Popular Culture
The protagonist of the television series Doctor House , Gregory House, suffered a heart attack of the quadriceps of the thigh , which causes constant chronic pain and is forced to take Vicodin . About how this diagnosis was made to House, the episode " Three Stories " tells.
Notes
- ↑ internetmedicin.se> Artäremboli / thrombos Professor David Bergqvist. Reviewed by Professor Joar Svanvik
- ↑ Ganong, Review of Medical Physiology, 22nd Edition. Specialized form of muscle that is peculiar to the vertebrate heart.p81
- ↑ 1 2 eMedicine Specialties> Bone Infarct Author: Ali Nawaz Khan. Coauthors: Mohammed Jassim Al-Salman, Muthusamy Chandramohan, Sumaira MacDonald, Charles Edward Hutchinson
- ↑ 1 2 Campbell WB, Ridler BM, Szymanska TH (November 1998). "Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland." Br J Surg. 85 (11): 1498-503. doi: 10.1046 / j.1365-2168.1998.00906.x. PMID 9823910 .
- ↑ 1 2 Kirurgiska åtgärder vid akut ischemi i nedre extremitet. (Google Translate: Surgical measures in acute ischemia of lower extremities.) Pekka Aho och Pirkka Vikatmaa. Finska Läkaresällskapets Handlingar (Finnish Medical Society Documents). No. 1, 2003
- ↑ 1 2 3 Grigoriadis E, Fam AG, Starok M, Ang LC (April 2000). "Skeletal muscle infarction in diabetes mellitus." J. Rheumatol. 27 (4): 1063-8. PMID 10782838 .
- ↑ 1 2 3 4 5 6 7 8 9 10 11 Arterial embolism | University of Maryland Medical Center
- ↑ 1 2 3 4 5 6 7 8 9 10 MD Guidelines> Arterial Embolism And Thrombosis From The Medical Disability Advisor by Presley Reed, MD