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Blood Clot In Heart: Cardiac Thrombosis Vs Coronary Thrombosis
Medically reviewed by Jeffrey S. Lander, MD
Blood clots can form both in the heart's chamber (intracardiac thrombosis) and the coronary arteries that feed the heart (coronary artery thrombosis). A blood clot in the heart's chambers can break apart and lodge into other arteries, such as the coronary arteries, leading to a heart attack. This is a medical emergency that requires immediate treatment. A blood clot in the heart's chambers isn't the same type of emergency but requires treatment to prevent complications.
This article will discuss the types of blood clots that can happen in the heart, symptoms to look for, and treatment considerations.
Blood Clot in the Heart: Formation and ComplicationsIntracardiac thrombus is a blood clot that occurs in the heart's chambers. The heart has four chambers: two upper chambers and two lower chambers. Common places for a blood clot in the heart are the left atrial appendage, an ear-shaped area off the upper left chamber of the heart, or the left ventricle, the main pumping chamber of the heart that pumps blood out to the body. Blood clots can also form on the right side of the heart, but often, they travel there from veins in the legs.
These blood clots can break apart and "embolize" or travel out of the heart chamber, leading to life-threatening complications:
Travel to the coronary arteries, leading to heart attack
Travel to the brain, leading to stroke
Travel to the arteries in the abdomen, leading to intestinal ischemia
Travel to arteries in the leg, leading to acute limb ischemia
Travel to the pulmonary arteries, leading to pulmonary embolism
The main risk factor for left atrial appendage thrombosis is atrial fibrillation. This is an arrhythmia, or abnormal heart rhythm, in which the heart's upper chambers quiver instead of fully contracting in an organized pattern. This leads to stagnant blood in the appendage, which causes clot formation ( thrombosis). Risk factors for atrial fibrillation include:
The heart's main pumping chambers, the ventricles, are another site where thrombosis can occur. It's often caused when blood stagnates along parts of the heart that don't contract well or when foreign material exists in the heart. Risk factors include:
Risk factors for blood clots in the right side of the heart and pulmonary embolism include:
Deep vein thrombosis (a blood clot in large veins)
Cancer
Recent surgery
Obesity
Taking certain hormone-containing medications, like estrogen-containing birth control
Pregnancy
Blood clots in the heart may not cause any symptoms. However, when a blood clot in the heart travels and lodges in, or embolizes to, the coronary artery, it causes a heart attack. Symptoms of a heart attack include the following:
Chest pressure or discomfort that may radiate to the neck, jaw, or arm
Shortness of breath
Nausea
Lightheadedness or dizziness
Fatigue
If you experience symptoms of a heart attack, call 9-1-1 immediately for an ambulance to transport you to an emergency room for evaluation—every minute counts during a heart attack.
Atrial fibrillation is a common cause of blood clots in the left atrium. The blood clot itself does not cause any symptoms, but people with atrial fibrillation may experience:
Blood clots in the right side of the heart can cause pulmonary embolism. These often originate in the legs, known as deep vein thrombosis. Symptoms to watch for include:
Leg swelling, redness, and pain
Shortness of breath
Chest pain that is worse with taking a deep breath
Fast heart rate
Fast breathing
Coughing up blood
The treatment for a blood clot in the heart depends on its location. Intracardiac thrombus, a blood clot in the heart's chambers, is generally treated with anticoagulant medications (blood thinners). More powerful blood thinners that break up the clot, known as thrombolytics, are used in some cases.
The use of blood thinning medications to treat intracardiac thrombi lowers the risk of complications due to embolism. Jantoven (warfarin) is the preferred medication for blood clots in the left heart chambers. Direct oral anticoagulant medications (DOACs), such as Eliquis (apixaban), or Xarelto (rivaroxaban) may be considered in some cases. Anticoagulation medications are typically taken for at least three to six months. After that time, imaging tests can be performed to see if the thrombus is still in the heart to guide further treatment. Some people may need lifelong blood thinners.
In the event of a heart attack, a cardiologist (heart doctor) may perform a cardiac catheterization and place a stent to open up the blood vessels. Antiplatelet medications, such as aspirin and Plavix (clopidogrel), Brillinta (ticagrelor), or Effient (prasugrel), are given to help keep the stent open and prevent more blood clots.
In some cases, a surgeon may perform a procedure called a thrombectomy. This procedure involves the use of special instruments to remove the blood clot.
How Do Doctors Diagnose Blood Clots in the Heart?Healthcare providers diagnose blood clots in the heart chambers using imaging. One common test is the echocardiogram, which uses sound waves to produce images of the heart, allowing for evaluation of its structure and function. A more invasive type of ultrasound, known as a transesophageal echocardiogram, is needed to diagnose blood clots in the atrial appendage.
Other imaging tests, such as computed tomography scans (CAT scans) or magnetic resonance imaging (MRI), can also show blood clots in the heart. However, the coronary arteries are much harder to see using ultrasound. Blood clots in these areas are diagnosed using coronary angiography with cardiac catheterization, a procedure that also allows for immediate treatment.
Can It Dissolve on Its Own?The body does have a mechanism for breaking down blood clots on its own. However, leaving a blood clot to dissolve on its own carries the risk of life-threatening complications, including strokes and heart attacks. Treatment with blood thinners can help the clot dissolve more quickly, prevent more clots from forming, and lower the risk of embolism.
Your healthcare provider can determine the appropriate treatment for your situation.
Factors That Affect Survival and Ability to RecoverIn many cases, blood clots can be successfully treated. However, blood clots in the heart may be more likely to embolize and cause complications in certain situations:
Mobile thrombus (meaning it is moving independently from the heart's contraction)
Protrusion into the left ventricle
Failure of thrombus to improve with blood thinners
The treatment timeline also affects mortality. For example, for coronary thrombosis, a delay in treatment increases the mortality rate.
Post-Coronary Thrombosis (Heart Attack) ConsiderationsAfter a heart attack, the risk of additional heart attacks or stroke increases. Lifelong treatment with medications and lifestyle changes can lower the risk of experiencing complications. These include:
Taking antiplatelet medications like aspirin
Taking cholesterol-lowering medications like statins
Controlling blood pressure with medications when needed
Getting regular exercise and staying as active as possible
Eating a heart-healthy diet rich in vegetables, fruits, and whole grains and low in processed foods and saturated fats
Quitting smoking
Getting enough good quality sleep
Managing weight
Controlling blood sugar
If you develop a blood clot in your heart, you will need to follow up with a cardiologist regularly. For intracardiac thrombi, your healthcare provider can review imaging tests to ensure the clot goes away with treatment and help manage any underlying conditions that led to the formation of the blood clot, such as heart failure or atrial fibrillation.
For those with intracoronary thrombus or heart attack, regular follow-up with your healthcare provider is needed to monitor your condition and help lower your risk of future complications. Your healthcare team will carefully monitor your blood pressure, cholesterol, and blood sugar.
Certain preventable measures can help keep your heart as healthy as possible. These include:
Getting regular exercise and staying as active as possible
Eating a heart-healthy diet rich in vegetables, fruits, and whole grains and low in processed foods and saturated fats
Controlling blood pressure
Controlling cholesterol levels
Quitting smoking
Getting enough good quality sleep
Managing weight
Controlling blood sugar
In summary, blood clots can occur in the heart's chambers (intracardiac thrombus) or the coronary arteries feeding the heart (coronary artery thrombosis). Clots in the heart chambers may not cause any symptoms but can break apart and travel to the coronary arteries, leading to a heart attack. Early detection and treatment of blood clots in the heart with blood thinners can prevent complications like heart attack and stroke.
A heart attack is a medical emergency that requires immediate treatment to prevent complications like arrhythmias and death. If you experience symptoms of a heart attack, such as chest discomfort that may radiate to the neck, jaw, or arm, nausea, or shortness of breath, seek medical attention immediately.
Read the original article on Verywell Health.
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Hypertensive Heart Disease
Hypertensive heart disease refers to heart conditions caused by high blood pressure.
The heart working under increased pressure causes some different heart disorders. Hypertensive heart disease includes heart failure, thickening of the heart muscle, coronary artery disease, and other conditions.
Hypertensive heart disease can cause serious health problems. It's the leading cause of death from high blood pressure.
In general, the heart problems associated with high blood pressure relate to the heart's arteries and muscles. The types of hypertensive heart disease include:
Narrowing of the arteriesCoronary arteries transport blood to your heart muscle. When high blood pressure causes the blood vessels to become narrow, blood flow to the heart can slow or stop. This condition is known as coronary heart disease (CHD), also called coronary artery disease.
CHD makes it difficult for your heart to function and supply the rest of your organs with blood. It can put you at risk for heart attack from a blood clot that gets stuck in one of the narrowed arteries and cuts off blood flow to your heart.
Thickening and enlargement of the heartHigh blood pressure makes it difficult for your heart to pump blood. Like other muscles in your body, regular hard work causes your heart muscles to thicken and grow.
This alters the way the heart functions. These changes usually happen in the main pumping chamber of the heart, the left ventricle. The condition is known as left ventricular hypertrophy (LVH).
CHD can cause LVH and vice versa. When you have CHD, your heart must work harder. With severe LVH, your heart can become enlarged, causing an obstruction of blood leaving the heart. This can then lead to symptoms of coronary artery disease.
ComplicationsBoth CHD and LVH can lead to:
Heart disease is the leading cause of death for both men and women in the United States. Over 695,000 Americans die from heart disease every year.
The main risk factor for hypertensive heart disease is high blood pressure. Your risk increases if:
You're more prone to heart disease if it runs in your family. Men are more likely to get heart disease than women who have not gone through menopause. Men and postmenopausal women are equally at risk. Your risk for heart disease will increase as you age, regardless of your sex.
Symptoms vary depending on the severity of the condition and progression of the disease. You may experience no symptoms, or your symptoms may include:
You need emergency care if your heart is suddenly beating rapidly or irregularly. Seek emergency care immediately or call 911 if you faint or have severe pain in your chest.
Regular physical exams will indicate whether you suffer from high blood pressure. If you do have high blood pressure, take extra care to look out for symptoms of heart disease.
Your doctor will review your medical history, conduct a physical exam, and run lab tests to check your kidneys, sodium, potassium, and blood count.
One or more of the following tests may be used to help determine the cause of your symptoms:
Treatment for hypertensive heart disease depends on the seriousness of your illness, your age, and your medical history.
MedicationMedications help your heart in a variety of ways. The main goals are to prevent your blood from clotting, improve the flow of your blood, and lower your cholesterol.
Examples of common heart disease medications include:
It's important to always take all medications exactly as prescribed.
Surgeries and devicesIn more extreme cases, you may need surgery to increase blood flow to your heart. If you need help regulating your heart's rate or rhythm, your doctor may surgically implant a battery-operated device called a pacemaker in your chest.
A pacemaker produces electrical stimulation that causes cardiac muscle to contract. Implantation of a pacemaker is important and beneficial when cardiac muscle electrical activity is too slow or absent.
Cardioverter-defibrillators (ICDs) are implantable devices that can be used to treat serious, life threatening cardiac arrhythmias.
Coronary artery bypass graft surgery (CABG) treats blocked coronary arteries. This is only done in severe CHD. A heart transplant or other heart-assisting devices may be necessary if your condition is especially severe.
Long-term outlookRecovering from hypertensive heart disease depends on the exact condition and its intensity. Lifestyle changes can help keep the condition from getting worse in some cases. In severe cases, medications and surgery may not be effective in controlling the disease.
Monitoring and preventing your blood pressure from getting too high is one of the most important ways to prevent hypertensive heart disease. Lowering your blood pressure and cholesterol by eating a healthy diet and monitoring stress levels are possibly the best ways to prevent heart problems.
Maintaining a healthy weight, getting adequate sleep, and exercising regularly are common lifestyle recommendations. Talk with your doctor about ways to improve your overall health.
How serious is hypertensive heart disease?Hypertensive heart disease is a serious condition that requires treatment. It increases your risk of death and puts you at risk of developing other cardiovascular diseases like heart failure, atrial fibrillation, and stroke, as well as chronic kidney disease.
How long does it take for hypertension to cause heart damage?Long-term high blood pressure ultimately leads to heart damage, and often heart failure. The length of time to develop heart damage varies for each person and depends on how uncontrolled your blood pressure is and what markers are used to determine LV damage. Treatment of high blood pressure can help prevent damage to the heart.
Can heart damage from hypertension be reversed?A 2016 study found that after 6 months of treatment, a person had succeeded in reversing heart damage caused by hypertension. That said, it's not always possible to reverse heart damage caused by high blood pressure. Following a well-development treatment plan can help you manage symptoms and prevent disease progression.
Prevention Of Coronary Artery Disease
Coronary artery disease (CAD) is the leading cause of death in the United States for males and females. Making changes to diet, lifestyle, and physical activity levels can improve heart health and may help to prevent CAD.
CAD, also known as coronary heart disease, is when the arteries narrow due to a buildup of plaque. While it is a serious condition, it is also preventable.
A person can help prevent CAD by addressing factors that increase their risk, as well as adopting habits that can protect against it.
Multiple factors can put someone more at risk of developing CAD. Many of these factors may be within a person's control, such as:
As a result, the things that may help prevent CAD include:
Some risk factors for CAD are not within a person's control. These include:
While someone cannot change these, addressing other factors can still lower the risk of CAD.
While not relevant to everyone, smoking is an important risk factor for cardiovascular disease (CVD), which is the leading cause of death in the United States.
According to the Food and Drug Administration (FDA), around 20% of annual deaths from CVD are due to smoking. Passive or secondhand smoke can also raise this risk.
Smoking tobacco harms the heart and blood vessels. When someone inhales tobacco smoke, they breathe in chemicals that can cause plaque buildup in the arteries, known as atherosclerosis.
To reduce the risk of CAD, people should avoid exposure to secondhand smoke. If relevant, they can also stop smoking themselves.
For support, people can talk with a healthcare professional or smoking cessation service about ways to quit. Options such as behavioral programs, nicotine replacement therapy, and medications may help.
A diet high in refined sugar, trans fats, sweetened beverages, and red or processed meats has associations with CAD. Saturated fat is also connected to CAD, although its significance is less clear.
Eating a heart-healthy diet can lower the risk of heart disease. It can also help address other underlying conditions that contribute to CAD, such as diabetes, obesity, and high cholesterol.
Diet recommendations generally involve limiting sugar, trans fats, saturated fats, and salt. There are also a few specific food plans that aim to preserve heart health.
For example, the Dietary Approaches to Stop Hypertension (DASH) diet focuses on:
The Mediterranean diet is a similar eating plan that can also benefit heart health. It prioritizes eating fruits, vegetables, whole grains, legumes, nuts, and fish.
Regular physical activity is important for heart health. Exercise can help address high cholesterol, blood pressure, or blood sugar levels and aid in weight management.
In people with CAD, exercise can also reduce the rate of cardiovascular events, such as heart attacks and stroke.
The CDC recommends getting 150 minutes of moderate-intensity activity each week. Examples of moderate-intensity activities include brisk walking, cycling, and swimming.
However, a 2018 review of previous research suggests that overall cardiovascular fitness as a result of vigorous activity may be more important than the duration of the exercise.
One of the major causes of CAD is underlying conditions that affect the heart and blood vessels, such as:
Following the prevention steps in this article for reducing CAD risk can also reduce the likelihood of these conditions, too. However, these conditions can affect anyone. Also, some, such as high blood pressure, may not cause any noticeable symptoms.
For this reason, it is important to have regular health check-ups with a doctor. People can discuss with a doctor whether at-home blood pressure or sugar monitors could help with monitoring their health.
If someone has an underlying condition that puts them at risk for CAD, they should consult a doctor about the best treatment options for them.
While CAD is serious, it is often preventable. A person can help prevent CAD by addressing the risk factors they may be able to change, such as smoking, an imbalanced diet, and a lack of exercise.
Even among people who do not smoke, it is important to avoid exposure to secondhand smoke. Reducing alcohol consumption, stress, and salt intake may also help.
Monitoring and managing conditions that raise the risk of CAD, such as high blood pressure, is a key part of CAD prevention. People who have concerns about their cardiovascular health can speak with a doctor for advice and treatment options.
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