Coronary thrombosis

Coronary thrombosis. Blood clot developed in one of these arteries, interrupting the blood supply to one of the areas of the same.

Typically, it causes severe chest pain behind the breastbone, which often spreads to the left arm. The area of ​​the muscle that does not have enough supply stops working properly, if the blood clot does not dissolve quickly, for example with a medicine that dissolves the thrombus (thrombolytic).

Summary

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  • 1 Training
  • 2 Risk factors
  • 3 Symptoms
    • 1 Symptoms of danger
  • 4 Diagnosis
  • 5 Treatment
  • 6 Medications
  • 7 Exams
  • 8 Physical consequences
  • 9 Mental consequences
  • 10 Future prevention
  • 11 Source

Training

Coronary thrombosis, which usually occurs in the coronary arteries, often develops where a arteriosclerotic plaque breaks. Most people in the developed world suffer from atherosclerosis (hardening of the arteries), in some parts of the body, without even realizing it. Atherosclerosis can start around age twenty and gradually develop as you get older.

Some people have symptoms of atherosclerosis in the coronary arteries, which show up as angina (chest pain). In contrast, plaque rupture leading to coronary thrombosis usually occurs in people without a prior history of angina.

The lining of the artery that supplies the heart muscle with water is the one that forms the arteriosclerotic plaque. If the diseased area of ​​the coronary artery ruptures, it can develop a blood clot, which is made up of blood clotting proteins, platelets, and red blood cells. This formation can interrupt the blood supply, and is called a blood clot.

Risk factor’s

  • A family history of arteriosclerosis
  • High blood cholesterol content
  • Hypertension (high blood pressure)
  • Smoking
  • Being male
  • Type 1 and type 2 diabetes
  • Overweight
  • Stress
  • Lack of exercise.

Symptoms

  • Sudden pain behind the breastbone (the central bone of the chest), or in the left front of the chest.
  • A possible extension of pain to the left arm.
  • Pain can also spread to the hands, jaw, ear, stomach, or right arm.
  • A feeling of tightness in or around the throat.
  • Sporadic, severe breathing difficulties can occur with or without pain.
  • Sudden fainting or severe dizziness, often accompanied by pain.

Symptoms of danger

If severe chest pain suddenly occurs, or any of the symptoms mentioned above, it could be coronary thrombosis.

If you have already had angina and the prescribed nitroglycerin does not seem to be going well, it could be a sign of danger. In so-called stable angina, pain usually occurs only after some effort has been made, and the effort required to bring it about is often always the same.

A major symptom of danger is that the degree of effort required for angina to occur begins to decrease. You have to worry when angina occurs without any effort. If, suddenly, angina occurs at rest and lasts more than 20 minutes, the patient should call the ER (112 in almost all of Europe) to request an ambulance.

The hospital will decide whether it is a myocardial infarction (coronary thrombosis), severe angina (chest pain), or something else entirely.

Diagnosis

Once in the hospital, the doctor makes the patient’s medical history, examines him and performs an electrocardiogram (ECG). In most cases, it will reveal if there is an occlusion of a coronary artery. However, the test is not one hundred percent safe, and in some cases, a small clot may be missed, affecting a small area of ​​the heart.

If pain persists, a second ECG may be done 30 minutes later. Once the patient has been admitted, a series of blood samples are taken during the first 24 hours of hospital stay, which will reveal the presence and extent of injury to the heart muscle.

Treatment

On arrival at the hospital, the patient is given aspirin (acetylsalicylic acid), if he has not taken any before. This prevents platelets (small blood cells) from sticking to each other in the clot. Treatment that dissolves the clot that complicates thrombosis (thrombolytic) is usually administered directly into a vein in the forearm.

For this treatment it is of vital importance that many hours have not elapsed since the onset of heart attack pain; Its maximum effectiveness is in the first six hours.

An alternative is an emergency dilation (widening) of the blocked coronary artery using a balloon, a procedure known as coronary angioplasty. Sometimes this dilation procedure is complemented by the placement of a stent or “spring” that reinforces the dilation produced by the angioplasty balloon.

It is usually only performed in specialized centers, but it should be considered if the patient has a constant low blood pressure (cardiogenic shock).

It is important to receive treatment as soon as possible, as soon as symptoms begin. The sooner it is administered, the better the result.

Medicines

  • Acetylsalicylic acid (aspirin)

It is always prescribed, unless the patient is intolerant to it. It has a mild blood thinning effect and can prevent other coronary episodes. The patient must take aspirin for the rest of his life. Clopidogrel can be administered as a substitute if the patient is aspirin intolerant.

  • Nitroglycerin (which dilates the arteries)

It can be prescribed in tablets, in patches that stick to the skin, or as a spray to treat episodes of chest pain. Long-lasting oral nitrate can reduce attacks of angina, and is helpful in reducing the duration of these attacks.

  • Beta-blockers

Among other effects, they block the action of the hormone adrenaline in the heart and, therefore, reduce blood pressure, as the heart beats more slowly. This reduces the work of the heart, and increases the flow of blood in the coronary arteries.

  • Calcium-antagonists

They reduce muscle tension in the arteries, dilating them and therefore allowing greater blood flow. In addition, they slightly relax the muscle and reduce the need for oxygen. Different types of calcium antagonists are available that have different effects on the heart rhythm, coronary arteries, heart and circulation. These drugs are not usually used just after coronary thrombosis, but they can be used to treat angina in the long term.

  • ACE inhibitors (angiotensin converting enzyme)

They prevent the formation of a hormone (angiotensin) that causes blood vessels to constrict, and can increase thickening of the heart, away from the attack site. When the pressure in the veins is reduced, the work of the heart decreases. It can be a useful medicine to improve the functioning of the heart and to prevent later complications after a heart attack. The doctor is likely to prescribe such a medication unless the patient has a constant low blood pressure.

  • Diuretics

These medications help the body secrete superfluous fluids and salts, lower blood pressure, and may be helpful if failure occurs. Diuretics can have different effects on the kidneys and can be divided into thiazides, high-ceiling diuretics, potassium-sparing diuretics, and a combination of both. Potassium is often added orally, since the kidneys remove a lot of potassium when the patient is treated with diuretic medication. Optionally, potassium tablets can be taken with diuretics. Medicines that lower cholesterol (for example, statins) If cholesterol levels are too high, they can help reduce the production of natural cholesterol in the liver. Statins inhibit an enzyme called HMG-CoA reductase,

Exams

  • Stress test

It takes place on an exercise bike or treadmill, where a constant ECG can be performed. The test can show if there are areas of the heart with insufficient oxygen supply. After having suffered a myocardial infarction due to thrombosis, she is currently undergoing a stress test before leaving the hospital.

It is usually performed between four and six weeks after discharge, in cases that were not performed before hospital discharge, unless the patient suffers from angina after the attack while in the hospital.

  • Ultrasound of the heart (echocardiography)

The ultrasound shows the doctor how the heart pumps, and the extent of the injury caused by thrombosis.

  • Coronary artery examination (coronary arteriography)

It consists of an injection of a contrast medium into the coronary arteries. Shows stenosis (narrowing), or occlusion (obstruction), in the coronary arteries that may require treatment.

Physical consequences

After you have coronary thrombosis (a heart attack), a scar will develop in the heart muscle, and this part of the muscle will work worse. Much of the muscle is transformed into fibrous tissue (connector) and therefore the pumping action is lost. The loss of the patient’s physical capacity will be in proportion to the extent of the coronary injury.

Frequently, small injuries will not be noticed later. Areas with major injuries can decrease long-term functional level, reduce the amount of physical work the patient can do, and increase the likelihood of failure. An echocardiogram before discharge can show the doctor the extent of the injury. Many patients feel tired immediately after coronary thrombosis and need much more sleep.

Mental consequences

Sometimes a depression can appear after coronary thrombosis, along with the feeling of being physically tired. Many people fear relapse, which can affect their overall mood. This usually occurs when the hospital does not have an exercise rehabilitation program. Depressed patients should seek help from family, friends, and their doctor.

Future prevention

  • Quit smoking: the most important thing is to quit smoking; It is also important that your partner does not smoke.
  • Exercise regularly: Twenty minutes of exercise three times a week, for example on an exercise bike, or walking will help to significantly lower high cholesterol levels.
  • Eat a healthy diet: you should take fatty fish or white meat (chicken) and reduce the consumption of red meat. All food should be grilled and nothing fried should be eaten. You should take plenty of fruit or vegetables daily.

 

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