Coronary thrombosis

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Coronary thrombosis
Thrombosis formation.gif
A medical animation showing the process of a thrombosis blocking the blood vessel
Specialty Cardiology   OOjs UI icon edit-ltr-progressive.svg
Complications Heart attack

Coronary thrombosis is defined as the formation of a blood clot inside a blood vessel of the heart. This blood clot may then restrict blood flow within the heart, leading to heart tissue damage, or a myocardial infarction, also known as a heart attack. [1]

Contents

Coronary thrombosis is most commonly caused as a downstream effect of atherosclerosis, a buildup of cholesterol and fats in the artery walls. The smaller vessel diameter allows less blood to flow and facilitates progression to a myocardial infarction. Leading risk factors for coronary thrombosis are high low-density lipoprotein cholesterol, smoking, sedentary lifestyle, and hypertension. [2]

Signs and symptoms

A coronary thrombus is asymptomatic until it causes significant obstruction, leading to various forms of angina or eventually a myocardial infarction. Common warning symptoms are crushing chest pain, shortness of breath, and upper body discomfort. [2]

Pathogenesis

Coronary thrombosis and myocardial infarction are sometimes used as synonyms, although this is technically inaccurate as the thrombosis refers to the blocking of blood vessels with a thrombus, while myocardial infarction refers to heart tissue death due to the consequent loss of blood flow to the heart. Due to extensive collateral circulation, a coronary thrombus does not necessarily cause tissue death and may be asymptomatic.[ citation needed ]

The formation of coronary thrombosis generally follows the same mechanism as other blood clots in the body, the coagulation cascade. Also applicable is the Virchow's triad of blood stasis, endothelial injury, and hypercoagulable state. Atherosclerosis contributes to coronary thrombosis formation by facilitating blood stasis as well as causing local endothelial injury.[ citation needed ]

Due to the large number of cases of myocardial infarction leading to death and disease in the world, there has been extensive study towards the generation of clots specifically in the coronary arteries.[ citation needed ] Some areas of focus:

Diagnosis

Coronary angiography of a patient with a heart attack. Coronary angiography of a STEMI patient, showing partial occlusion of left circumflex coronary artery.jpg
Coronary angiography of a patient with a heart attack.

Clinical signs of myocardial infarction (heart attack) or angina if coronary thrombus is symptomatic:

Imaging modalities used to evaluate the presence of coronary thrombi: [9]


Postmortem examiners may look for Lines of Zahn, to determine whether blood clotted in the heart vessels before or after death. [11]

Management

Management of symptomatic coronary thrombosis follows established treatment algorithms for myocardial infarction. Treatment options include: [12]

To address the possibility of identifying and treating asymptomatic coronary artery disease to prevent development of coronary thrombosis, a study published 2018 determined that preemptive treatment with percutaneous coronary intervention did not lead to a difference in death or myocardial infarction over a 15-year period. [13]

There are numerous treatments currently being studied for management and prevention of coronary thrombosis. Statin drugs, in addition to their primary cholesterol-lowering mechanisms of action, have been studied to target a number of pathways that may decrease coronary inflammation and subsequent thrombosis. [14]

Another realm of potential treatments in early stages of adoption is in therapeutic use of contrast ultrasound on thrombus dissolution. [15]

Notable people

Terminology

Thrombosis is defined as the formation of a thrombus (blood clot) inside a blood vessel, leading to obstruction of blood flow within the circulatory system. Coronary thrombosis refers to the formation and presence of thrombi in the coronary arteries of the heart. Note that the heart does not contain veins, but rather coronary sinuses that serve the purpose of returning de-oxygenated blood from the heart muscle.[ citation needed ]

A thrombus is a type of embolism, a more general term for any material that partially or fully blocks a blood vessel. An atheroembolism, or cholesterol embolism, is when an atherosclerotic plaque ruptures and becomes an embolism. Atherosclerosis is the progressive thickening of blood vessels and plaque formation that eventually can lead to coronary artery disease.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Atherosclerosis</span> Form of arteriosclerosis

Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. These lesions may lead to narrowing of the arteries' walls due to buildup of atheromatous plaques. At onset there are usually no symptoms, but if they develop, symptoms generally begin around middle age. In severe cases, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney disorders, depending on which body parts(s) the affected arteries are located in the body.

<span class="mw-page-title-main">Embolism</span> Disease of arteries, arterioles and capillaries

An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule, a bubble of air or other gas, amniotic fluid, or foreign material. An embolism can cause partial or total blockage of blood flow in the affected vessel. Such a blockage may affect a part of the body distant from the origin of the embolus. An embolism in which the embolus is a piece of thrombus is called a thromboembolism.

<span class="mw-page-title-main">Thrombosis</span> Medical condition caused by blood clots

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus.

<span class="mw-page-title-main">Embolus</span> Unattached mass that travels through the bloodstream

An embolus is an unattached mass that travels through the bloodstream and is capable of creating blockages. When an embolus occludes a blood vessel, it is called an embolism or embolic event. There are a number of different types of emboli, including blood clots, cholesterol plaque or crystals, fat globules, gas bubbles, and foreign bodies, which can result in different types of embolisms.

<span class="mw-page-title-main">Thrombus</span> Blood clot

A thrombus, colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of cross-linked fibrin protein. The substance making up a thrombus is sometimes called cruor. A thrombus is a healthy response to injury intended to stop and prevent further bleeding, but can be harmful in thrombosis, when a clot obstructs blood flow through healthy blood vessels in the circulatory system.

<span class="mw-page-title-main">Ischemia</span> Restriction in blood supply to tissues

Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism. Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue i.e. hypoxia and microvascular dysfunction. It also implies local hypoxia in a part of a body resulting from constriction. Ischemia causes not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolic wastes. Ischemia can be partial or total blockage. The inadequate delivery of oxygenated blood to the organs must be resolved either by treating the cause of the inadequate delivery or reducing the oxygen demand of the system that needs it. For example, patients with myocardial ischemia have a decreased blood flow to the heart and are prescribed with medications that reduce chronotrophy and ionotrophy to meet the new level of blood delivery supplied by the stenosed vasculature so that it is adequate.

<span class="mw-page-title-main">Interventional cardiology</span>

Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist Charles Dotter.

Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment. It allows the application of ultrasound technology, such as piezoelectric transducer or CMUT, to see from inside blood vessels out through the surrounding blood column, visualizing the endothelium of blood vessels.

<span class="mw-page-title-main">Cerebral infarction</span> Medical condition

Cerebral infarction is the pathologic process that results in an area of necrotic tissue in the brain. It is caused by disrupted blood supply (ischemia) and restricted oxygen supply (hypoxia), most commonly due to thromboembolism, and manifests clinically as ischemic stroke. In response to ischemia, the brain degenerates by the process of liquefactive necrosis.

An embolus, is described as a free-floating mass, located inside blood vessels that can travel from one site in the blood stream to another. An embolus can be made up of solid, liquid, or gas. Once these masses get "stuck" in a different blood vessel, it is then known as an "embolism." An embolism can cause ischemia—damage to an organ from lack of oxygen. A paradoxical embolism is a specific type of embolism in which the embolus travels from the right side of the heart to the left side of the heart and lodges itself in a blood vessel known as an artery. Thus, it is termed "paradoxical" because the embolus lands in an artery, rather than a vein.

<span class="mw-page-title-main">Percutaneous coronary intervention</span> Medical techniques used to manage coronary occlusion

Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). The stent delivery balloon from the angioplasty catheter is inflated with media to force contact between the struts of the stent and the vessel wall, thus widening the blood vessel diameter. After accessing the blood stream through the femoral or radial artery, the procedure uses coronary catheterization to visualise the blood vessels on X-ray imaging. After this, an interventional cardiologist can perform a coronary angioplasty, using a balloon catheter in which a deflated balloon is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as stents can be deployed to keep the blood vessel open.

<span class="mw-page-title-main">Vascular disease</span> Medical condition

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal. Coronary heart disease for example, is the leading cause of death for men and women in the United States.

<span class="mw-page-title-main">Drug-eluting stent</span> Peripheral or coronary stent

Drug-eluting stents (DES) are a type of stent and a medical drug delivery device used in the treatment of various medical conditions, with its primary application being the treatment of coronary artery disease (CAD).

<span class="mw-page-title-main">Coronary stent</span> Medical apparatus implanted into coronary arteries

A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention (PCI). Coronary stents are now used in more than 90% of PCI procedures. Stents reduce angina and have been shown to improve survival and decrease adverse events in an acute myocardial infarction.

<span class="mw-page-title-main">Coronary artery aneurysm</span> Medical condition

Coronary artery aneurysm is an abnormal dilatation of part of the coronary artery. This rare disorder occurs in about 0.3–4.9% of patients who undergo coronary angiography.

<span class="mw-page-title-main">Myocardial infarction</span> Interruption of blood supply to a part of the heart

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, feeling tired, and decreased level of consciousness. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.

<span class="mw-page-title-main">Arterial embolism</span> Interruption of blood flow to an organ

Arterial embolism is a sudden interruption of blood flow to an organ or body part due to an embolus adhering to the wall of an artery blocking the flow of blood, the major type of embolus being a blood clot (thromboembolism). Sometimes, pulmonary embolism is classified as arterial embolism as well, in the sense that the clot follows the pulmonary artery carrying deoxygenated blood away from the heart. However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins. Arterial embolism is the major cause of infarction.

<span class="mw-page-title-main">Left ventricular thrombus</span> Medical condition

Left ventricular thrombus is a blood clot (thrombus) in the left ventricle of the heart. LVT is a common complication of acute myocardial infarction (AMI). Typically the clot is a mural thrombus, meaning it is on the wall of the ventricle. The primary risk of LVT is the occurrence of cardiac embolism, in which the thrombus detaches from the ventricular wall and travels through the circulation and blocks blood vessels. Blockage can be especially damaging in the heart or brain (stroke).

Blood vessel disorder generally refers to the narrowing, hardening or enlargement of arteries and veins. It is often due to the build-up of fatty deposits in the lumen of blood vessels or infection of the vessel wall. This can occur in various locations such as coronary blood vessels, peripheral arteries and veins. The narrowed arteries would block the blood supply to different organs and tissues. In severe conditions, it may develop into more critical health problems like myocardial infarction, stroke or heart failure, which are some of the major reasons of death.

<span class="mw-page-title-main">Arterial occlusion</span>

Arterial occlusion is a condition involving partial or complete blockage of blood flow through an artery. Arteries are blood vessels that carry oxygenated blood to body tissues. An occlusion of arteries disrupts oxygen and blood supply to tissues, leading to ischemia. Depending on the extent of ischemia, symptoms of arterial occlusion range from simple soreness and pain that can be relieved with rest, to a lack of sensation or paralysis that could require amputation.

References

  1. Klatt MD, Edward C. "Atherosclerosis". Spencer S. Eccles Health Sciences Library. The University of Utah . Retrieved 13 January 2019.
  2. 1 2 "Heart Attack | National Heart, Lung, and Blood Institute (NHLBI)". www.nhlbi.nih.gov. Retrieved 2020-06-16.
  3. 1 2 Lüscher, Thomas F.; Steffel, Jan; Eberli, Franz R.; Joner, Michael; Nakazawa, Gaku; Tanner, Felix C.; Virmani, Renu (27 February 2007). "Drug-Eluting Stent and Coronary Thrombosis: Biological Mechanisms and Clinical Implications". Circulation . 115 (8): 1051–8. doi: 10.1161/CIRCULATIONAHA.106.675934 . PMID   17325255.
  4. Borovac, Josip Anđelo; D'Amario, Domenico; Niccoli, Giampaolo (September 2017). "Neoatherosclerosis and Late Thrombosis After Percutaneous Coronary Intervention: Translational Cardiology and Comparative Medicine from Bench to Bedside". The Yale Journal of Biology and Medicine. 90 (3): 463–470. ISSN   1551-4056. PMC   5612188 . PMID   28955184.
  5. Sexton, Travis; Smyth, Susan S. (January 2014). "Novel mediators and biomarkers of thrombosis". Journal of Thrombosis and Thrombolysis. 37 (1): 1–3. doi:10.1007/s11239-013-1034-5. ISSN   1573-742X. PMC   4086911 . PMID   24356857.
  6. Skyschally, Andreas; Erbel, Raimund; Heusch, Gerd (April 2003). "Coronary microembolization". Circulation Journal. 67 (4): 279–286. doi: 10.1253/circj.67.279 . ISSN   1346-9843. PMID   12655156.
  7. Wu, Han; Li, Ran; Pei, Li-Gang; Wei, Zhong-Hai; Kang, Li-Na; Wang, Lian; Xie, Jun; Xu, Biao (2018). "Emerging Role of High Mobility Group Box-1 in Thrombosis-Related Diseases". Cellular Physiology and Biochemistry: International Journal of Experimental Cellular Physiology, Biochemistry, and Pharmacology. 47 (4): 1319–1337. doi: 10.1159/000490818 . ISSN   1421-9778. PMID   29940562.
  8. 1 2 W, Masood; Kk, Sitammagari (2020), Coronary Sinus Thrombosis, PMID   29939583 .
  9. Lablanche, J. M.; Perrard, G.; Chmait, A.; Meurice, T.; Sudre, A.; Van Belle, E. (November 2002). "[Coronary thrombosis imaging in humans]". Archives des Maladies du Coeur et des Vaisseaux. 95 Spec No 7: 15–20. ISSN   0003-9683. PMID   12500600.
  10. Abanador-Kamper, Nadine; Kamper, Lars; Castello-Boerrigter, Lisa; Haage, Patrick; Seyfarth, Melchior (January 2019). "MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries". Diagnostic and Interventional Radiology (Ankara, Turkey). 25 (1): 28–34. doi:10.5152/dir.2018.18004. ISSN   1305-3612. PMC   6339625 . PMID   30582569.
  11. Baumann Kreuziger, Lisa; Slaughter, Mark S.; Sundareswaran, Kartik; Mast, Alan E. (November 2018). "Clinical Relevance of Histopathologic Analysis of HeartMate II Thrombi". ASAIO Journal. 64 (6): 754–759. doi:10.1097/MAT.0000000000000759. ISSN   1538-943X. PMC   6093800 . PMID   29461277.
  12. Akcay, Murat (July 2018). "Evaluation of thrombotic left main coronary artery occlusions; old problem, different treatment approaches". Indian Heart Journal. 70 (4): 573–574. doi:10.1016/j.ihj.2017.09.006. ISSN   2213-3763. PMC   6117801 . PMID   30170655.
  13. "Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation". American College of Cardiology. Retrieved 2020-06-19.
  14. Sexton, Travis; Wallace, Eric L.; Smyth, Susan S. (2016). "Anti-Thrombotic Effects of Statins in Acute Coronary Syndromes: At the Intersection of Thrombosis, Inflammation, and Platelet-Leukocyte Interactions". Current Cardiology Reviews. 12 (4): 324–329. doi:10.2174/1573403x12666160504100312. ISSN   1875-6557. PMC   5304247 . PMID   27142048.
  15. Slikkerveer, Jeroen; Juffermans, Lynda Jm; van Royen, Niels; Appelman, Yolande; Porter, Thomas R.; Kamp, Otto (February 2019). "Therapeutic application of contrast ultrasound in ST elevation myocardial infarction: Role in coronary thrombosis and microvascular obstruction". European Heart Journal - Acute Cardiovascular Care. 8 (1): 45–53. doi:10.1177/2048872617728559. ISSN   2048-8734. PMC   6376593 . PMID   28868906.