Why is a detached blood clot deadly?

Why is a blood clot dangerous?

A thrombus is a blood clot that is located in a blood vessel or in the cavity of the heart. It is usually formed in response to damage to blood vessels and literally seals them. This way people avoid severe blood loss. As soon as the clot performs its functions, it disintegrates under the action of enzymes.

Where do pathogenic blood clots come from? The fact is that clots can appear without ruptures in the vessels. Moreover, they unstick from the vessel and begin to “travel” along the bloodstream, blocking the cross-section of arteries, veins and capillaries.

Along the way, blood clots sometimes break up into small particles, aggravating the situation.

Blood clots enter:

• into the vessels of the brain;
• kidney;
• intestines;
• lower extremities;
• into the pulmonary arteries.

Why does pathology lead to death? A blood clot deprives the tissue of blood flow, which means oxygen and nutrition.

Broken blood clots are called emboli or thromboemboluses.

Gradually, the cells begin to die, which can cause the person himself to die. An embolus infected with pathogenic bacteria becomes even more dangerous.

A thrombus is a blood clot that is a block in the path of blood flow. If a blood clot blocks the blood vessels of the heart, the person will have a heart attack; if it blocks the blood vessels of the brain, the person will have a stroke. Read more in the article: “how to prevent a blood clot from breaking off in the body.”

How do blood clots occur?

If a blood clot has formed on the wall of an artery, its appearance can be described in the following stages:

1. Some process damages the artery wall.
2. The body notices the violation and begins to build protection against blood loss, forming a large number of special blood cells - platelets, which, attaching to the damaged area, form a kind of patch.
3. In case of coagulation disorders or changes in the hematopoietic system, platelet formation does not stop on time and continues longer than expected. This causes too much growth to form on the wall. Or platelets, which are in small quantities in the blood, floating past in the bloodstream, stick to the resulting accumulation.

The causes of damage to the walls of blood vessels can be:

• mechanical disruption of the structure due to injury;
• infectious lesion;
• high levels of glucose molecules in the blood;
• immune system dysfunction.

If there are no factors that contribute to the formation of blood clots, any injury or other damage will not lead to a large accumulation of blood cells. Under the layer of platelets, the artery wall will heal and recover, and the crust will resolve over time.

There are several stages of thrombus formation:

• disruption of the structure of the inner surface of the artery;
• activation of blood clotting factors;
• platelet adhesion at the site of injury;
• the appearance of substances that trigger a chain of reactions that form fibrin threads, which contribute to thrombus formation;
• a kind of network of fibrin threads is formed, into which blood cells enter, creating a large clot;
• Over time, the clot thickens, forming a thrombus.

When a blood clot breaks off under the influence of any factors, it begins to move through the bloodstream. Once it hits the nearest bottleneck, the blood flow will be blocked. If a similar situation happens outside a medical facility, it is impossible to save the person.

Causes of pathology

In addition to tissue rupture, thromboembolism occurs for the following reasons:

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1. Due to disruption of blood flow
   . Blood clots do not form when blood flows quickly through the vessels, even if the vascular walls are damaged. But a slow current with stagnation provokes their appearance. The root causes of such phenomena are lack of movement, compression of veins and arteries, and varicose veins.

2. Due to changes in blood composition
   . It can become thicker due to lifestyle and environmental influences. Density can be affected by viruses and bacteria, and some medications.
   Read also:  Varicose veins of the esophagus: causes, treatment, complications

This pathogenic phenomenon is common to many diseases. In some cases it becomes its cause, in others it becomes a complication.

The rhythm of life, stress, and the flow of information make it necessary to have sedatives on hand. Which of them are safe for health and are allowed without a prescription. Features of sedative drugs A large group of drugs has a sedative effect. Read more in the article: “a good quick-acting sedative for nerves.”

The Last Fireworks: What Happens to the Body When We Die

As a patient approaches death, changes occur in his body. They concern breathing, blood circulation, consciousness. We explain in detail what happens: if we understand death, perhaps we will be less afraid of it.

Author: Jacob Zimmank

The author of the article is a former employee of the palliative care service, which supervises dying people at home. He was amazed at how calmly many people faced their own death.

When does dying begin? At what point does a person begin his path to death?

Dying begins long before we are born. It is laid in the womb, in a cluster of cells from which the unborn child is formed. Some cells are redundant and need to make room for new ones. This is the only way the child’s organs can appear. It is due to this that there are only two kidneys, and only ten fingers on the hand. The genome of each cell already contains programs that act as a kind of “catapult”. It turns on at the moment when the cell becomes unnecessary or dangerous for the body. In this case, the cell voluntarily destroys itself.

Becoming a person is a process that involves both life and death. According to palliative medicine doctor Jean-Domenico Borasio, death is “a necessary condition so that we can, in principle, be born as viable organisms.”

“What we know for certain is that a person does not die suddenly, overnight” - Jean-Domenico Borasio, palliative care doctor

Death is omnipresent - but once we are born, we forget about it. And, if all is well, then death will appear in our lives again only after a few decades. Often this will be a condition that cannot be cured: cancer, heart disease, or kidney disease that means they can no longer cleanse the blood. And then the process of dying begins.

“What we know for certain is that a person does not die suddenly, overnight. The organs of the human body stop functioning gradually, not all at the same time, and then at some point their work stops,” says Dr. Borasio. As a result of the chain reaction, the liver, kidneys, lungs and heart stop working.

There are a variety of diseases, but at the end of life everything always follows the same pattern: the heart stops beating, breathing stops and, last of all, consciousness fades away. At the same time, it is very difficult to separate the work of the heart and brain. If the heart stops pumping oxygenated blood, brain cells begin to die within seconds. And after a few minutes, brain death occurs: at this moment the EEG will show a straight line instead of the usual curves and teeth. The reflexes that control the deep parts of the brain responsible for breathing, swallowing and consciousness also stop working. Thus, when the heart stops, the brain also stops working.

It also happens the other way around. The brain contains centers that regulate all vital functions: blood pressure, heart function, breathing. If these centers are damaged, breathing will stop and the heart rhythm will be disrupted. Often this damage occurs when intracranial pressure rises sharply as a result of a car accident or accident. The bones of the skull are hard, so with a strong blow, the soft tissue of the brain is squeezed into the only natural opening in the skull - the foramen magnum. Through it, the cranial cavity communicates with the spinal canal (the spinal cord passes into the brain stem). If the brain stem is pinched or damaged, the person dies.

There are no clear signs, but there are general patterns

Dying people live the last years, months and days of their lives in different ways. “The dying process is very individual,” says Lukas Radbruch, president of the German Society for Palliative Medicine and professor at the University Hospital Bonn. It often lasts for months or even years. Doctors divide dying into three stages: at the beginning comes the “terminal” stage, which lasts one to two years. At this time, the functioning of individual internal organs gradually decreases, and the dying person increasingly experiences fatigue. This is followed by the “pre-final” stage, which can last several weeks or months. At this time, symptoms such as shortness of breath and pain appear. And finally, the “final” stage - the last days. The patient stops eating and drinking and slowly fades away. “It is important to remember that this division of dying into stages is nothing more than a convention,” notes Radbruch. It is important for providing treatment and care, but does not provide an accurate picture and “does not help determine when the patient will die.”

“It used to be believed that the approach of death was indicated by pale skin in the nasolabial triangle,” says Radbruch. But this is also an unreliable sign. Currently, research that allows us to accurately determine the time of death is at an early stage. Some scientists are testing blood samples for markers that can be used to calculate remaining life expectancy. Radbruch says the best thing to do is ask the attending physician: Would she be surprised if she learned that the patient died that night or next weekend? If the doctor says that she is not surprised, then it is time to prepare for death.

Part 2. Death rattle

Although dying is a highly individual process, there are certain physical changes that are common to most patients (Palliative Care Review: Plonk & Arnold, 2005). As we approach death, there are more and more similar features, although the cause of death may be different. The dying are exhausted, have difficulty breathing and experience pain. Breathing changes: at first it becomes shallow, then intermittent, but after a while the dying person can again take a deep breath.

Doctors suggest that by this time the centers of the brain responsible for breathing have already been affected. They react late to the presence of carbon dioxide in the blood, allowing it to accumulate in large quantities. In some cases, breathing noises occur, one of which used to be called the “death rattle.” Due to the inability to expectorate and clear the throat, secretions accumulate in the pharynx and bronchi, which affects the passage of air flow during breathing.

The death rattle is often a terrible sound, but there is no evidence that the dying person is suffering at this moment. The same applies to an increase in the level of carbon dioxide in the blood - it is assumed that this has a rather calming and soporific effect. The death rattle (as the name suggests) indicates that death is imminent (American Journal of Hospice and Palliative Medicine: Morita et al, 1998). With very little time left, wheezing may become uncontrollable.

In addition, in the last days and hours before death, changes in blood circulation are observed. The body tries to deliver the small amount of oxygen that the heart is still able to pump through the blood to vital organs. “The pulse weakens and is often barely palpable, the hands become cold and the lips may turn blue,” explains Lukas Radbruch. “It’s a stress reaction.” In some cases, the heart begins to beat faster, the blood pressure drops, and a slight fever may even appear.

When consciousness fades

Radbruch says: “Someone remains conscious until his last breath. Another may experience anxiety and even hallucinations. And the third one just quietly fades away.”

There are enough reasons for such changes. On the one hand, due to uneven flow of blood and oxygen, brain metabolism is disrupted. On the other hand, some organs stop working, and because of this, toxic substances accumulate in the blood. For example, urea, which is excreted through the kidneys, can damage nerve cells in high concentrations. (But the dying person does not suffer from this either. Oblivion caused by a high concentration of urea in the blood is similar to anesthesia - it does not hurt the person, it is even pleasant.)

In addition to urea, ketone bodies accumulate in the blood of a dying person in large quantities, which also affect a person’s consciousness. They are produced from fat and, in conditions of energy deficiency, are used by the body as a substitute for glucose, which is necessary to nourish the brain and muscles. This is exactly what happens when dying: a person stops eating, but does not experience hunger (JAMA: McCann et al., 1994).

When dying, many patients quietly fade away or, on the contrary, become excited and whisper something excitedly. It may seem that they have already left this world, but despite this, “we must treat the dying as if they understood everything,” emphasizes Lukas Radbruch. “We don’t know exactly how much they can take in.”

Many patients continued to perceive what was happening even after cardiac arrest. This is evidenced by the results of a large study. Scientists interviewed 140 people from the UK, Austria and the US who had experienced cardiac arrest. Nine percent of those surveyed reported having had a near-death experience such as feeling fear, seeing a light or seeing family members.

Two of the respondents remembered the process of their own resuscitation. One of them talked about watching the doctors’ actions from above, from the corner of the room. He remembers that the doctors turned on the defibrillator and tried to “start” the heart, make it beat at the right rhythm again. And this coincided with what was happening in reality. It is interesting that the patient regained consciousness only a few minutes after cardiac arrest.

Last fireworks

When the heart stops and stops supplying the brain with oxygen, nerve cells do not die immediately. On the contrary, their activity increases sharply. This was reported by scientists who studied the electrical activity of the brain in laboratory rats (the rat’s brain is in many ways similar to the human brain). A few minutes after the rodents' hearts stopped beating, a burst of electrical activity could be observed—exceptionally strong. “This may explain why the memories of patients who have experienced clinical death are so real and accurate,” writes one of the study authors, anesthesiologist George Mashour of the University of Michigan Medical School.

When the heart stops, a real fireworks display occurs in the brain. Nerve cells release enormous amounts of norepinephrine, which affects the frontal lobes of the brain and sharpens attention. There is also a release of serotonin, so hallucinations and mystical insights are possible. And at the very last moment, dopamine arrives from the midbrain. It is responsible for the feeling of satisfaction, gives a feeling of warmth and joy. Perhaps even happiness.

The original interview is on ZEIT ONLINE.

We thank Vera Foundation volunteer Veniamin Sapozhnikov for translating this article.

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SIMILAR

Who is predisposed to pathology?

Experts have identified conditions that affect susceptibility to pathogenic thrombus formation. The risk group includes:

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1. Men over 40 years old
   . The functioning of the cardiovascular system worsens and blood clotting increases.

2. Women over 50 years old
   . Before menopause, women's blood is regularly renewed.

3. Overweight people
   . Cholesterol, which is deposited on the walls of capillaries, becomes a threat.

4. Alcohol abusers
   . Excess alcohol in the blood removes water from the body and causes platelets to stick together.

5. People with low physical activity
   . Exercising prevents the formation of stagnation in the blood.

6. Pregnant women and new mothers
   . During this period, hormones are produced that help increase blood clotting.

7. For the same reason - taking hormonal contraceptives.

8. People after surgery
   . Blood clots often form after operations on the heart and joints.

9. Lovers of coffee and strong tea
   . Caffeine constricts blood vessels, which leads to poor blood flow.

10. Smoking
    . Nicotine also leads to a decrease in the lumen of blood vessels.

The appearance of thrombosis is associated with diagnoses of oncology and inflammation, varicose veins and diabetes, atherosclerosis and heart disease.

Thrombosis factors

An increased risk of blood clots is caused by:

• Genetic inheritance to predisposition.
• Diseases that force you to limit physical activity, for example, bed rest.
• High degree of blood clotting.
• Arrhythmia, cardiomyopathy and other diseases that disrupt the strength and rhythm of blood flow throughout the system.
• Varicose veins.
• Liver dysfunction.
• Alcoholism.
• Smoking.
• High body mass index.
• Age-related changes in hormone levels in both men and women.

Some of these factors cannot be influenced, for example, genetic predisposition. However, you can protect yourself from the serious consequences of blood clots by maintaining an active and healthy lifestyle.

Symptoms of the disease

It is quite difficult to diagnose yourself. And if a blood clot comes off, it’s even more difficult.

A blood clot that breaks off in the heart, lungs, or brain usually results in death.

But experts call a number of symptoms that signal serious danger:

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• if the pathogen has formed in the leg, then it begins to hurt, heat up, turn red and swell;
• if it reaches the brain, then speech and coordination are impaired, paralysis appears, the face becomes distorted - all signs of a stroke;
• if in the vein that carries blood from the brain, then vision deteriorates and the head hurts;
• if in the pulmonary arteries, then the person begins to choke and turn blue;
• if in the digestive organs, then vomiting and pain in the stomach appear, which radiates to the shoulder;
• if in the heart, then sharp pain, tachycardia, loss of consciousness;
• if in the portal vein, then abdominal pain appears and liver cirrhosis gradually develops.

Usually everything happens suddenly. Few people can understand in practice what it means that a blood clot breaks off and a person dies.

If a blood clot comes off, what should you do?

If a person has a blood clot, then you cannot hesitate to call an ambulance. Moreover, even a doctor will not be able to make an accurate diagnosis without special equipment. Therefore, the victim must be urgently hospitalized.

There can be two treatment regimens for thrombosis: either the patient is prescribed medication correction or he is referred for surgery.

Drug therapy includes:

• Prescription of anticoagulants. These drugs help thin the blood (Heparin, Warfarin).
• Course treatment with statins.
• Prescription of fibrinolytics.
• Prescribing thrombolytics, which are necessary to dissolve the blood clot.

If the problem cannot be solved with the help of medications, or the person develops complications of thrombosis, he is indicated for an operation called thrombectomy. It is also possible to install special vena cava filters that will “catch” blood clots, preventing them from clogging vital vessels.

Possible consequences

They depend on where the blood clot clogged the vessel:

• if in the brain, then a stroke occurs;
• if in the coronary arteries - myocardial infarction;

• if in the intestines, then - necrosis, peritonitis of this organ;
• if in the legs, then gangrene is possible.

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Stagnant blood is a favorable environment for microorganisms. An infected embolus can cause sepsis.

How to determine deep vein thrombosis?

Thrombosis often occurs asymptomatically or with mild symptoms. The nature of patient complaints may vary depending on the location of the blood clot, the duration of the disease and the nature of the lesion. The main symptom of deep vein thrombosis is pain in the leg, namely in the calf muscle. Swelling may also be a concern. When a blood clot forms in the deep veins of the lower extremities, the skin may take on a reddish or blue tint.

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“Signs of thrombosis can manifest themselves as swelling and pain in the lower extremities, and the location of this pain can be very diverse. Sometimes you can’t guess what the pain is due to: either osteochondrosis, or blood clots, or other diseases. Therefore, if your legs swell, or there are varicose veins in your legs, then you should pay attention to the possible development of blood clots,” says Shpachenko. An ultrasound duplex scan or angiography will help you understand the exact picture.

Diagnosis of pathology

Timely diagnosis will help you avoid surgical intervention and save your life. People who are at risk should undergo the examination.

It is worth systematically diagnosing both young men and women, because the disease is noticeably younger.

The following methods help to identify the presence of a detached blood clot:

To reduce the risk of a pathological process, it is important to engage in prevention.