On the horizon: Squeezing the arm to protect the heart

A simple treatment that involves nothing more than a standard blood pressure cuff could protect heart muscle during a heart attack or improve the outcome of bypass surgery or artery-opening angioplasty. The procedure, called remote ischemic preconditioning, works like this: An emergency medical technician or doctor inflates a blood pressure cuff over the upper arm for five minutes, cutting off blood flow to the arm. He or she releases the pressure, restoring blood flow, then repeats the pressure on–pressure off cycle a few more times. This stress causes the body to release chemical messengers that prepare heart cells to withstand both a period of low oxygen supply and the restoration of blood flow — just what they experience during a heart attack or angioplasty.

Early work on the phenomenon of remote ischemic preconditioning in the laboratory and in animals has led to its application in humans. In a British study, remote ischemic preconditioning improved the results of angioplasty (Circulation, Feb. 17, 2009). In a Danish study, it limited the amount of damage caused by a heart attack (Lancet, Feb. 27, 2010). Clinical trials are under way to confirm these findings and perhaps extend remote ischemic preconditioning to other situations, such as heart transplantation or activities that cause chest pain (angina).