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Arterial thrombosis

Medicine > Cardiovascular

Background knowledge 🧠

Definition

  • Arterial thrombosis refers to the formation of a blood clot within an artery, obstructing blood flow to vital organs.
  • It can result in tissue ischaemia and infarction, depending on the vessel affected.
  • Common sites include coronary arteries, cerebral arteries, and peripheral arteries.

Epidemiology

  • Arterial thrombosis is a leading cause of morbidity and mortality globally.
  • It is associated with conditions like coronary artery disease, stroke, and peripheral arterial disease.
  • Prevalence increases with age, smoking, diabetes, and hyperlipidaemia.
  • More common in men but risk equalises in post-menopausal women.

Aetiology and Pathophysiology

  • Atherosclerosis: Plaque rupture and subsequent thrombosis formation.
  • Endothelial injury: Trauma, infections, or autoimmune processes.
  • Platelet aggregation: Triggered by vascular injury or inflammation.
  • Hypercoagulability: Inherited thrombophilias or acquired conditions like cancer.

Types

  • Coronary artery thrombosis: Causes myocardial infarction.
  • Cerebral artery thrombosis: Leads to ischaemic stroke.
  • Peripheral artery thrombosis: Affects limbs, can cause gangrene.

Clinical Features 🌡️

Symptoms

  • Chest pain: Typically crushing or squeezing in coronary artery thrombosis.
  • Sudden weakness or numbness: Common in stroke.
  • Pain, pallor, or paraesthesia in affected limb.
  • Shortness of breath and diaphoresis in myocardial infarction.

Signs

  • Reduced or absent pulse in affected area.
  • Hypotension and tachycardia in acute coronary syndromes.
  • Neurological deficits in stroke (e.g., hemiplegia, aphasia).
  • Cool, cyanotic, or mottled skin in peripheral thrombosis.

Investigations 🧪

Tests

  • ECG: To assess for myocardial infarction.
  • CT or MRI: Used to detect ischaemic stroke.
  • Doppler ultrasound: Evaluates blood flow in peripheral arteries.
  • Blood tests: FBC, D-dimer, coagulation profile.
  • Coronary angiography: Definitive test for coronary artery thrombosis.

Management 🥼

Management

  • Antiplatelets: Aspirin or clopidogrel to prevent further thrombus formation.
  • Anticoagulation: Heparin or warfarin for stroke or peripheral thrombosis.
  • Thrombolysis: Used acutely in ischaemic stroke or STEMI (within time limits).
  • Surgery: Embolectomy or bypass graft in peripheral artery thrombosis.
  • Lifestyle modification: Smoking cessation, diet, and exercise.

Complications

  • Myocardial infarction: Can lead to heart failure or arrhythmias.
  • Stroke: Long-term neurological deficits (e.g., hemiplegia).
  • Limb ischaemia: May lead to amputation if untreated.
  • Post-thrombotic syndrome: Chronic pain and swelling after DVT.

Prognosis

  • Depends on the location of the thrombosis and timing of intervention.
  • Early treatment improves outcomes, especially in myocardial infarction and stroke.
  • Peripheral arterial disease carries a higher risk of morbidity and amputation.

Key Points

  • Arterial thrombosis is a life-threatening condition requiring urgent treatment.
  • Early recognition and intervention can reduce morbidity and mortality.
  • Prevention through lifestyle changes is key in high-risk populations.
  • Management often requires a multidisciplinary approach.

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Cardiovascular