Migration of clots to blood vessels of lungs – pulmonary embolism

Clot in lung vessel

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.

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Thyroid and heart disease

Thyroid and heart

How is thyroid linked to heart disease?

Heart disease can occur with both increased function of the thyroid gland and decreased function of the thyroid gland. When thyroid function is increased, heart rate increases and the work load of the heart increases. In severe cases heart failure may occur. A peculiarity of heart failure associated with increased thyroid function is that it is a high output failure unlike the usual heart failure in which the pumping function of the heart is reduced and low output failure occurs. While in low output heart failure the extremities are cold, in high output failure due to increased thyroid function, the extremities of the limbs are warm. Another important issue with increased thyroid function is that the heart rhythm may become irregular. This condition is known as atrial fibrillation, in which the upper chambers of the heart generate very fast irregular signals, but fail to contract well. Hence the blood stagnates in some parts of the upper chambers (left atrium) and clots may form. If these clots migrate to the blood vessels of the brain, a stroke may result.

Reduced function of the thyroid gland is also associated with heart disease. Cholesterol levels go up when thyroid function comes down. This in turn can enhance the chance of plaque build up in the blood vessels of the heart (coronary arteries). When thyroid function is very low, fluid collects in various parts of the body. This may occur within the covering of the heart known as pericardium. Collection of fluid within the covering of the heart is called pericardial effusion. If it is severe enough to compress the heart, it prevents proper filling of the heart and blood pressure falls.

Stroke and heart disease

Stroke and heart disease

How are stroke and heart disease related?

Stroke is often due to sudden loss of blood supply to a region of the brain which usually results in paralysis of a part of the body. Stroke could also be due to bleeding into a part of the brain. Strokes and heart disease are linked together in various ways. In general, risk factors for stroke and some forms of heart disease are similar. Strokes due to blocks in blood vessels, can be seen along with blocks in blood vessels of the heart. Stroke can occur after a heart attack as well. Heart attack damages a part of the heart muscle. This can lead to damage of the inner lining of the heart in that region. A blood clot can form on the inner surface of the heart as a consequence. These clots can break away into the circulation and get lodged into a blood vessel of the brain. The clot thus blocks a blood vessel of the brain and causes stroke.

Another type of heart disease which leads to stroke is an abnormal rhythm of the heart known as atrial fibrillation. In atrial fibrillation, there is a fast irregular rhythm originating in the upper chambers of the heart. The rhythm is so fast that effective contractions of the upper chambers cease. This leads to stagnation of blood in certain parts of the left atrium (upper chamber of the heart), where a blood clot can form. These clots can also get dislodged and travel to blood vessels of the brain. They in turn block a blood vessel of the brain and cause stroke.

Another reason for stroke is high blood pressure. When the blood pressure goes very high suddenly, small blood vessels in the brain may break leading to a bleed into the brain matter. This form of stroke (hemorrhagic stroke) is generally more dangerous than a stroke due to blockage of a blood vessel. Even without a bleed, brain function can be altered due to high blood pressure, causing alteration in the level of consciousness. But then that is not a stroke, but called as hypertensive encephalopathy (brain disease due to high blood pressure).

Coronary Steal – Who is stealing what?

Coronary arteries - blood vessels of heart

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.

Stress and heart disease

Stress and heart

How does stress cause heart disease?

Stress and heart disease has various aspects. Stress can lead to increase in risk factors for heart disease as well as precipitate symptoms in a hitherto silent heart disease. Most older persons have build up of plaques in the blood vessels of the heart (coronary arteries). When there is a sudden severe stress, heart rate and blood pressure can shoot up. This can lead to increase of shear stress on the fat plaques in the blood vessels of the heart. A small break may form in the covering of the plaque, exposing the inner cells. Blood components known as platelets adhere to these breaks in the inner surface of the blood vessels and initiate the formation of blood clots. Blood clots in turn block the flow of blood in the vessel, leading to damage of heart muscle known as heart attack.

Sudden stress can sometimes lead to a surge in the blood levels of certain hormones like adrenaline. These contribute to the surges in blood pressure and heart rate. In addition this can upset the heart rhythm leading to life threatening rhythm disorders (cardiac arrhythmia) which can sometimes cause sudden stoppage of the heart (cardiac arrest).

Another manifestation of stress in the heart is the ‘broken heart syndrome‘ or stress cardiomyopathy. This was initially described more in elderly females after sudden demise of their spouse. Part of the left ventricle (lower muscular chamber of the heart) becomes enlarged, giving it the name apical ballooning. This occurs in the absence of any blockage to the blood supply. Most of these cases do recover sooner or later. Stress cardiomyopathy has been described along with multiple other forms of stress other than bereavement.

Stress in general changes our life style and we may eat more of carbohydrate and fat. This has long term consequences like increase in body weight, blood sugar and blood pressure. These can further increase the chance of heart disease. Stress increases the blood pressure and blood sugar through hormonal influences even without a change in the diet pattern.

Coronary Angioplasty

Balloon Angioplasty

Here is one of my old posts elsewhere on Coronary Angioplasty. It is supplemental to my recent post at: https://cardiophile.blog/category/angioplasty/

Angioplasty is a method to remove blocks from important blood vessels. The most common form of angioplasty is coronary angioplasty, the method of removing blocks from the blood vessels supplying oxygenated blood (arteries) to the heart. Coronary angioplasty was originally described by Andreas Gruentzig in 1975. He used a balloon at the tip of tiny long tubes known catheters to dilate narrowed coronary arteries. The procedure is also known as PTCA (Percutaneous Transluminal Coronary Angioplasty). Blood vessels supplying the brain, kidneys and the limbs can also be treated by angioplasty. Coronary angioplasty is usually done when one or more blood vessels supplying the heart are critically narrowed (> 70% decrease in diameter). The most important benefit of angioplasty is symptomatic relief, rather than improvement in survival. The procedure is done under local anaesthesia. The tiny tubes used for angioplasty can be introduced into the body either through the groin or above the wrist. The tubes are threaded back into the main artery of the body called aorta and from the aorta into the coronary arteries under x-ray fluoroscopic guidance. Initially iodine containing contrast dye is injected into the vessels to visualise the sites of narrowing. Read more…

Lungs and heart disease

lungs and heart disease

Can lung disease cause heart disease?

Heart disease as a consequence of lung disease is known as cor pulmonale. ‘Cor’ means related to heart and ‘pulmonale’ means related to the lungs. When there is severe lung disease, the blood vessels in the lung get destroyed or contract, increasing the blood pressure in the main blood vessels taking deoxygenated blood to the lung for oxygenation (pulmonary arteries). When the pressure in the pulmonary arteries rise (pulmonary hypertension), the strain on the right ventricle which pumps blood to the lungs increases. The right ventricular muscle gets thickened (right ventricular hypertrophy). When the load is more, the right ventricle becomes enlarged in addition to being thickened. If the lung disease is progressive, a stage may come when the right ventricle is unable to bear the extra load and may fail. When the right ventricle fails, the pressure in the right atrium increases. Walls of the right atrium gets thickened. Back pressure into the great veins which bring blood to the right atrium causes prominent distended neck veins (jugular veins). Increased pressure in the venous system of the abdomen and lower limbs cause excess fluid (edema) to collect in the lower limbs and abdomen (ascites). Increased pressure in the veins of the face give the face a congested appearance.