‘February, 2020’ Archive
Do You Have Cardiac Ischemia or Reperfusion Injury?
Ischemic Heart Disease
Ischemia-Reperfusion IRI is a risk following vascular or cardiovascular reperfusion procedures and post compartment syndrome fasciotomies. The severity depends on a combination of degree and duration of the occlusion and extent and type of tissue involved by the affected watershed area of capillary or arteriolar distribution.(1)
The following events occur with IRI:
- Tissue injury with tissue hypoxia and/or death from this initial ischemic insult occurs.
- Interrupted blood flow.
- Direct traumatic tissue injuries.
- Pressure induced injuries.
- Cold injuries or burns.
- Embolic, thrombotic, or localized inflammatory occlusion insults.
- Once circulation is restored, a secondary* recurrent ischemic effect may occur within the following 4 to 8 hours.
- Cell death can continue for up to 3 days.
- The release of endothelial chemotactic substances initiated by the original injury or insult creates an intravascular inflammatory response.
*This inflammatory response is at least partially responsible for further vascular occlusion of downstream tissues from edema. It is worsened by additional release from the second round of reactive oxygen species generated by the freshly oxygenated blood in an affected region that is depleted of protective free radical scavengers responding to the initial insult.
Hyperbaric oxygen therapy, if initiated early, has been found to ameliorate the damaging effects of reperfusion by:
- Early modulation of inflammation. (2)
- Maintenance of metabolic function in downstream tissues.(2)
- Reintroduction of oxidation scavengers.(3)
HBOT has potential clinical applications to treat ischemic pathologies.(4) The rationale and effects for using HBOT for reperfusion injury is demonstrated in a 1998 paper in the American Urological Journal , and in another study done by Departments of Internal Medicine, Undersea and Hyperbaric Medicine, Pathology, Nephrology, and Pediatrics, The Gulhane Military Medical Academy, Haydarpasa Training Hospital; Kadikoy in Istanbul, Turkey, demonstrated HBO showing marked improvement in tissue lesions’ healing
While HBOT has been studied after acute myocardial infarction (AMI) in conjunction with stenting/angioplasty and/or alteplase (tPA) administration, Eugene R. Worth, MD, M.Ed., FABA, ABPM/UHM, a board-certified anesthesiologist specialized in cardiac and vascular anesthesia, shares in this extensive article why he, as a doctor states the following:
“If I were scheduled to have an angioplasty/stenting or a CABG procedure, I would DEFINITELY approach the hyperbaric physician and cardiologist about having a standard wound healing HBOT treatment.
- Reduces risk of death.
- Preserves more myocardial tissue.
- Reduces intensive care unit (ICU) stay.
- Reduces overall blood loss.
- Preserves ejection fraction.
- Reduces restenosis rates.
- Promotes the VEGF-induced enhancement of antioxidant; endothelial nitric oxide synthase (eNOS). (5)
With the genomic production of many antioxidants and scavengers during HBOT, these catalysts affect mitogenic and anti-apoptotic actions to preserve the integrity of endothelium, thereby improving blood supply to ischemic tissues.
Hyperbaric oxygen reduces Ischemia-Reperfusion effects by interrupting leukocyte adhesion on the vascular walls, thereby diminishing inflammatory effects while inducing free radical scavengers to block further damage to the tissue as well as promotes the VEGF-induced enhancement of endothelial nitric oxide synthase (eNOS). All the while, hyperbaric oxygen supports metabolic function through high concentration oxygen diffusion.
For First Time, Data Demonstrates Promise of Regenerative Hyperbaric Oxygen Therapy (HBOT) Protocols to Improve Cardiac Function in Healthy Aging Heart Population. (6)
Drs. co-authored this research done at The Sagol Center for Hyperbaric Medicine and Research at Assaf Harofe Medical; one of the largest Hyperbaric centers worldwide.
“As we age, a decrease in mitochondrial function occurs throughout the body, impacting the functionality of organs, including the heart,” said Shai Efrati, MD, Director of the Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, and study co-author. “For the first time in humans, using our HBOT protocol, we have demonstrated the possibility of heart functionality improvement in healthy, aging people. The results of this study are in accordance with other studies demonstrating that HBOT can improve mitochondrial function.” (7)
Hyperbaric Oxygen, Vasculogenic Stem Cells, and Wound Healing
Authors; Katina M. Fosen and Stephen R. Thom offer this HBOT research because hyperoxia has effects of a number of cell signaling events that converge to influence cell recruitment/chemotaxis and gene regulation/ protein synthesis responses which mediate wound healing. As shown in above research, this research reiterates the following:
- Stem cells proliferation.
- HBOT can induce angiogenesis in different body organs.
- Wound- healing events related to elevated synthesis of nitric oxide.
- Nitric oxide plays a central role in synthesizing VEGF (45), cytokines, and growth factors
- Gene regulation/protein synthesis. The interruption of blood flow associated with acute injuries rapidly causes wound hypoxia, which contributes to stabilization of hypoxia-inducible factors (HIF).
As seen in the table above, beneficial HBOT starts a cascade of genomic events where Nitric Acid (NO) increases and anti inflammatory growth factors are released to synthesize and produce more and more growth factors. All of these genetic changes alter the bodies ability to fight AND decrease inflammation as well as decrease the pro-inflammatory precursors. (8)
THIS IS SO COOL!!
The Undersea and Hyperbaric Medical Society
has a list of approved indications for HBO therapy. (9)
Call us today for more information or to schedule a consultation with our Medical Hyperbaric Physician.
1118 Irwin St. San Rafael, CA 94901
Advanced Hyperbaric Medical Director, Jacqueline S. Chan, DO
Hyperbaric Physician is Board Certified in Neuromusculoskeletal Medicine
and Family Practice
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