Thrombus in the heart: symptoms and treatment
A blood clot in the heart is a common complication of cardiovascular pathology. Statistics indicate that in 43% of people who died from myocardial infarction, a thrombus was found in the heart cavity. Intracardiac thrombosis is a dangerous condition that can lead to death or disability.
Depending on the constituent elements, a blood clot in the heart can be of the following types:
- White (gray) thrombus. It consists of platelets, which form growths that are shaped like corals. Such a blood clot is dry and crumbly. Its favorite site of localization is the valve leaflets of the heart and the space between the trabecular muscles.
- A red thrombus is represented by a large number of erythrocytes; it is rarely found in pure form in the heart, mainly it forms in the veins.
- A mixed thrombus consists of erythrocytes and platelets. Such a clot has a head, neck and tail. This type of blood clot is often found in heart cavities.
- Tumor thrombus that develops against the background of the spread of metastases by malignant neoplasms. Tumor thrombus grows in the direction of blood flow and in some cases reaches the right atrium.
- A septic thrombus can form on the leaflets of the heart valves in acute ulcerative endocarditis. Such a thrombus is a carrier of infection.
The thrombus itself is a blood clot that attaches to the walls of the heart muscle. It is generally accepted that a blood clot in the heart is a pathology that develops mainly in the elderly. In fact, 38.8% of cases are actually diagnosed in women and men over the age of 70. However, WHO indicates that every year the number of patients aged 35-50 years with diagnosed intracardiac thrombi is increasing. Therefore, it is so important to understand exactly what mechanisms contribute to the formation of a blood clot in the heart, how this pathology manifests itself and how to avoid it.
- Causes of a blood clot in the heart
- Symptoms of a blood clot in the heart
- Danger of a blood clot in the heart
- Diagnosis of a blood clot in the heart
- Treatment of a blood clot in the heart
- Prevention of a blood clot in the heart
Causes of a blood clot in the heart
Modern medicine considers a blood clot in the heart as a multifactorial condition. This means that several reasons can provoke its appearance at once.
- Placement of a venous catheter.
- Congenital heart defects, ischemic heart disease. In this case, blood clots are most often formed on the left atrial appendage, or on the walls of the heart muscle.
- Postponed myocardial infarction in 60-65% of cases leads to the formation of a blood clot in the heart.
- In 5-10% of cases, rheumatic heart disease becomes the cause of the formation of an intracardiac thrombus.
- The danger is arrhythmias with left atrial fibrillation.
- Postponed septic endocarditis, rheumatic endocarditis. In this case, blood clots form on the flaps of the aortic valve or on the flaps of the mitral valve.
- The presence of a valve prosthesis in the heart.
Cardiomyopathies cause heart thrombus formation in 5% of cases.
- Atherosclerotic changes in the vessels. This pathology causes the formation of a parietal thrombus in the aorta, in the large arterial trunks that extend from the aorta.
- Pathological changes in the walls of the heart muscle.
- Blood flow disorders.
- Increased blood viscosity.
- Carriage of defective genes that determine the tendency to thrombophilia.
- In 4.7% of cases, blood clots in the heart can form due to the presence of a tumor in the body.
The following categories of citizens are at risk for increased formation of a blood clot in the heart:
- Pregnant women and women in the early postpartum period.
- Women taking hormonal contraceptives.
- Obese people.
- People with a sedentary lifestyle.
- People who abuse alcohol and coffee.
- Patients who have undergone surgery on the abdominal organs.
- Hypertensive patients.
Symptoms of a blood clot in the heart
Symptoms of a motionless thrombus in the heart may be absent for a long period of time. In some cases, this is manifested by tachycardia and the appearance of shortness of breath. In this case, shortness of breath occurs even when a person is at rest. All this time, the blood clot will remain in the heart in a motionless state.
If a blood clot in the heart is mobile and moves freely in its cavity, then this will be accompanied by the following symptoms:
- Heart palpitations. Patients compare this feeling with the movement of a foreign body, which is located inside the chest.
- Blue skin.
- Increased sweating.
- Loss of consciousness, or light-headedness.
- Weakening of the pulsation of the radial artery.
Thrombosis of the left atrium is combined with the development of gangrene of the fingers and with a sharp drop in blood pressure. In this case, the patient himself begins to suffocate.
If a blood clot bursts in the right atrium, then this situation leads to pulmonary thromboembolism. As a result, the person dies.
The following signs may indicate the presence of a blood clot in the heart:
- Treatment with antiarrhythmic drugs does not bring the desired effect.
- The patient develops pulmonary hypertension.
- Medicines do not reduce pain in the heart.
However, only a doctor can make an accurate diagnosis, based on a number of studies.
Danger of a blood clot in the heart
A blood clot in the heart, provided it is torn off, can lead to the development of a heart attack of the kidney, brain, and heart itself. There is also a risk of intestinal and limb gangrene formation. The incidence of these complications varies. So, gangrene of the legs is most often observed, which happens in 70-75% of cases. Cerebral infarction with a ruptured heart thrombus occurs in 10% of cases.
If a detached thrombus is additionally a carrier of bacterial flora, then this is a hello to septic infarction of those organs where it gets. In the future, this always entails a rapid purulent fusion of tissues and the development of an abscess. In this regard, infectious endocarditis is dangerous as an etiological factor affecting the formation of a heart thrombus.
The further prognosis of developing complications depends on how large the thrombus was, as well as on the zone of necrosis and the place of its localization. If the femoral artery is blocked, accompanied by gangrene of the leg, then death can be avoided. A good prognosis for survival can be made with thromboembolism of a heart thrombus of a branch of the renal or splenic artery.
Even the smallest blood clot in the middle cerebral artery poses a great danger in terms of the death of a patient.
Diagnosis of a blood clot in the heart
Diagnosis of intracardiac thrombosis is based on a thorough history of the clinical course of the disease. However, it is impossible to confirm the presence of a blood clot in the heart without instrumental examination.
In this regard, the following techniques are the most informative:
- Echocardio-doppleographic examination (transesophageal ECHO-KG and transthoracic ECHO-KG).
- Transesophageal ECHO-KG, which has almost 100% diagnostic value.
Auxiliary methods that allow one to suggest the presence of a blood clot in the heart are: scintigraphy, which allows to determine the degree of filling of the myocardium with blood, Doppler ultrasonography, which measures blood flow velocity and heart pressure. It is also possible to conduct MRI, which makes it possible to determine the presence of a heart tumor, the state of its tissues, the quality of its functioning. The sooner concomitant cardiovascular diseases are identified, the higher the likelihood that the patient's life will be saved.
Treatment of a blood clot in the heart
Prescribed drug therapy is the leading treatment for uncomplicated heart clots. The patient is prescribed drugs that help dissolve blood clots. However, in some cases, it is not possible to do without surgical intervention.
The choice of the treatment method remains with the specialist. This largely depends on the location of the thrombus, on the severity of the clinical picture, on the test results. If during the examination it was found that the patient has one or more small parietal thrombi, then it is reasonable to resort to conservative therapy.
It boils down to performing the following activities:
- Prescribing drugs that prevent increased blood clotting. It can be Warfarin, Fragmin, Clexane, Heparin.
- Intravenous administration of thrombolytic drugs designed to dissolve the fibrin fibers that make up the thrombus. These can be drugs such as: Streptokinase, Urokinase, Alteplase, etc.
- Prescribing antiplatelet drugs that interfere with the formation of blood clots. These can be drugs such as: Lamifiban, Acetylsalicylic acid, Ticlopidine, etc.
The operation is always associated with a number of risks and complications. Therefore, it is prescribed to patients in life-threatening situations. Surgical intervention is indicated for patients diagnosed with a spherical thrombus or a thrombus on the leg, which can lead to sudden death.
A blood clot in the heart can be removed in the following ways:
- Endoscopic thrombectomy. All manipulations on the heart are carried out using an endoscope, which is inserted into the atrial ears.
- Bypass grafting of the heart with the use of equipment that replaces its work during the operation.
- Stenting. In this case, to remove a thrombus, it is required to expand the coronary vessels using a special metal tube.
In the postoperative period, patients are prescribed antiplatelet agents for a long time, which reduces the risk of re-formation of blood clots.
Prevention of a blood clot in the heart
If a person is at risk for the formation of an intracardiac thrombus, then he must follow the following recommendations:
- Stick to a diet, excluding foods - sources of cholesterol from your diet. First of all, these are fried and fatty foods.
- Drink at least 2 liters of water per day to prevent an increase in blood viscosity.
- Lead a healthy lifestyle.
- Quit smoking and alcohol abuse.
- Go in for sports (do morning exercises, spend more time in the fresh air, take walks, etc.).
Since various diseases of the cardiovascular system most often lead to the formation of an intracardiac thrombus, first of all, it is necessary to direct efforts to prevent their development. If pathologies of the circulatory system already exist, then the patient needs regular observation by a doctor and registration with a cardiologist.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.