Migration of clots to blood vessels of lungs – pulmonary embolism

What is pulmonary embolism?

Blood clots may migrate along with blood flow from various parts of the body to the lungs and block the blood vessels of the lungs. This condition is known as pulmonary embolism. When only small clots reach the blood vessels of the lungs, only a small portion of the blood vessels of the lung is blocked and may not cause any problem. But when large clots or multiple clots migrate to the lungs and block major blood vessels of the lung or multiple blood vessels, it can cause significant problems. Lack of blood flow to regions of the lung cause wastage of air breathed in, which goes back without being utilized for oxygenating the blood. Hence the oxygen level in the blood falls, causing breathlessness and bluish discoloration of the skin in extreme cases. Blockage of parts of the blood circulation to the lung causes an increase in the blood pressure in the remain blood vessels. High blood pressure in the blood vessels of the lung leads to failure of the right ventricle (lower muscular chamber of the heart) which pumps blood into the lungs. When sufficient quantity of blood cannot be pumped to the lungs, the blood returning to the left atrium (upper chamber of the heart) also decreases, which in turn leads to lower volume of blood pumped into the rest of the body. This causes a fall in the blood pressure of the rest of the body. The individual feels dizziness and may faint in severe cases. It can be seen that massive pulmonary embolism is a life threatening situation demanding immediate medical attention.

Coronary Steal – Who is stealing what?

This is a revised version of my previous post elsewhere.

Coronary steal is the term given to blood being stolen from one region of the coronary tree by another. It is also called coronary steal syndrome. In fact the term steal is used in vascular medicine for one territory stealing blood from another territory. Another example of steal is subclavian steal in which the arm steals blood from the brain so that the person feels giddiness during arm exercise. Steal occurs when there is obstruction to one vessel which is connected to another. Coming back to coronary steal, it occurs when certain type of vasodilators (blood vessel dilating drugs) are given. The classical example is a drug called dipyridamole. Dipyridamole is both an antiplatelet drug and a vasodilator. When it is given to a person with partial obstruction to a coronary artery, all the coronary vessels dilate. Hence blood will flow preferentially to the non obstructed vessels, reducing the flow in the region of the obstructed vessel. Hence the drug given to improve the circulation will predispose to stealing of the blood into other regions. This is why dipyridamole is not used for this purpose usually. This disadvantage can be used in the form of dipyridamole stress test to bring out the deficiency of blood supply in a suspected case, if the person is unable to undergo a treadmill exercise test due to physical deficits in the legs. Another drug with similar effect is adenosine. Adenosine is used for pharmacological stress test now a days because it is short acting. Any reduction in blood supply to a region of the heart produced by adenosine is quickly reversed and unlikely to lead to long lasting cardiac damage.