What are the other Names for this Condition? (Also known as/Synonyms)
- Arterial Embolus
- Blood Clot in Artery, due to Embolism
- Embolic Arterial Occlusion
What is Arterial Embolism? (Definition/Background Information)
- Arterial Embolism is the sudden interruption of blood flow, due to a blood clot adhering to the wall of an artery. An artery supplies blood to an organ or body part
- Embolism is the term used to describe a blood clot that travels to another location, from the site where it is formed. The original site, where the blood clot formed, is called the site of thrombosis. When this thrombotic blood clot breaks, it causes an embolism
- 80% of arterial emboli originate in the heart and travel to the extremities (limbs); the lower extremities are affected much more frequently, than the upper extremities. A majority of these emboli occur in patients with significant underlying heart disease. The severity of the patient's underlying heart condition may increase the risk of surgery and limit the options available for restoring blood flow to the extremities
- When Arterial Embolism occurs in the brain, it results in oxygen-deprivation to the brain tissue. When oxygen levels are severely depleted, brain cells begin to die, which result in the symptoms of a stroke
- A heart attack occurs, when the flow of oxygen-rich blood, to a section of the heart muscle becomes obstructed. If the flow is not restored quickly enough, then that portion of the heart muscle begins to die
- Prompt diagnosis and early treatment can result in an excellent prognosis. A delayed medical management may result in a poor prognosis
Who gets Arterial Embolism? (Age and Sex Distribution)
- Arterial Embolism can occur in any individual, at any age. The incidence increases with age, due to genetic or lifestyle related plaque buildup, within the arteries
- No gender, racial, or ethnic predilection is observed
What are the Risk Factors for Arterial Embolism? (Predisposing Factors)
The risk factors of Arterial Embolism include the following:
- High blood pressure - the risk of developing high blood pressure increases with age. The condition is more common in males, than females
- High blood sugar - type 2 diabetes affects men and women equally (mostly in individuals, over 45 years old)
- Increased lipid levels in blood; a diet high in fat, cholesterol, and sugar can cause unhealthy body conditions. This could result in obesity, high triglyceride levels, low good cholesterol (HDL), and high bad cholesterols (LDL)
- Tobacco smoking: It contributes significantly to the risk factors by creating cholesterol level imbalance, limiting oxygen supply, and injuring the blood vessels
- Sedentary lifestyle, lacking physical activity and exercise
- Obesity or excess body weight - having an excess amount of stored fat increases the risk
- As an individual gets older, the risk of Arterial Embolism increases
- Increased platelet count clump at the site of blood vessel injury, a process that precedes the formation of blood clot
- Congenital heart condition, like patent foramen ovale
- Atrial fibrillation - the most common heart rhythm disorder in elderly patients; it increases the risk of Arterial Embolism
- Mitral stenosis: It is usually an acquired form of valve disease that is related to rheumatic fever. It increases the risk of atrial fibrillation. Mitral stenosis occurs due to the thickening and immobility of the mitral valve leaflets, which cause blood flow obstruction from the left atrium to the left ventricle. Such a mechanical obstruction leads to an increase in pressure within the left atrium. This causes atrial fibrillation, which increases the risk of blood stasis (blood stagnation)
- Infection of the heart, like endocarditis
- A history of stroke or a previous heart attack
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Arterial Embolism? (Etiology)
- The presence of atherosclerosis creates an environment for the formation of a clot, in the blood vessel. Generally, the arteries are smooth and resilient, permitting easy passage of blood. In atherosclerosis, sometimes the arteries become hard and clogged with a wax-like substance, composed of fat and other materials, called plaque. Infrequently, blood clots may develop, or bits of plaque may become dislodged from the arterial wall, which may obstruct the blood flow, or travel to other vital organs ( brain, heart, or lungs )
- There are other reasons that can increase one’s chances of forming blood clots in the blood vessels, such as genetic conditions, medications, and infections. Examples of genetic conditions that causes increased risk for blood clot formation include, factor V Leiden deficiency, protein S deficiency, and protein C deficiency
- The formation of the clot can cause serious damage, to various parts of the body. For example; a clot may form within an artery that supplies the brain (thrombus), or it may travel to the brain from the heart (or through an artery supplying the brain) and become lodged in a narrowed vessel (embolus). The result of such embolism is tissue and organ damage produced by multiple small artery occlusions. E.g. blue toe syndrome, retinal ischemia, renal failure, livedo reticularis, and intestinal infarction
What are the Signs and Symptoms of Arterial Embolism?
Arterial Embolism signs and symptoms are dependent upon the location, where the embolism occurs. These may include:
- Symptoms of Arterial Embolism in the limbs include: Weakness, cramps, change in skin color, feeling of numbness and tingling sensation, and pain in the affected area
- Arterial Embolism in the coronary artery that supplies the heart causes chest pain that is dull, sore, squeezing, or pressure like. Other symptoms include: Nausea, vomiting, sweating, pain radiating to the left arm associated with anxiety
- An embolus in the brain may affect the function, the affected part controls. This includes the ability to move, think, speak, and touch. When blood flow to the brain is disrupted, it can cause symptoms, such as speaking difficulties, loss of coordination, or even loss of muscle function
- If the abdominal blood vessels are involved, the patients can present with abdominal pain after meals that resolves in a few hours. The signs and symptoms may be either acute or chronic, with abdominal pain and bloody diarrhea
How is Arterial Embolism Diagnosed?
A diagnosis of Arterial Embolism would depend on the organ or location involved. The diagnostic tools would include:
- Physical examination with evaluation of medical history
- In case of embolism involving the coronary arteries, chest pain is the most common symptom. The initial tests for chest pain include electrocardiogram (EKG) and blood tests for elevation in cardiac enzymes
- In addition to these tests, an echocardiogram may be performed. An echocardiogram detects the heart wall motion abnormalities
- Angiography is used, to detect the location of the arterial disease, by injecting a special dye into the blood vessels and studying x-ray images. The results of the angiography helps a physician determine whether a bypass surgery or an angioplasty is a better treatment option
- Arterial duplex ultrasound: To test the flow of blood and if any obstructions are present, in the artery. This test is usually performed to determine blockage of the artery in the extremities and the carotid artery of the neck
- Blood tests to determine elevated enzymes, like cardiac specific troponin, CK-MB, blood sugar, and cholesterol levels
- Other imaging studies may include: CT angiography and MR angiography
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Arterial Embolism?
Depending on the site of embolism, the complications of Arterial Embolism vary. These include:
- In the case of the heart - myocardial infarction (heart attack), valvular heart disease, and heart failure may be the possible complications. A myocardial infarction can significantly affect the pumping function of the heart, resulting in either acute heart failure or chronic heart failure. Damage to the heart walls can result in the development of mitral valve regurgitation and aortic valve regurgitation
- In the case of the brain - stroke caused by a sudden blockage in the flow of blood, to the brain, may occur
- Mesenteric ischemia (ischemia of the bowel) may result from embolism. This is a life-threatening intestinal infarction and should be treated as a surgical emergency
- Embolus in the artery that supplies blood to the arms or legs may result in necrosis (tissue death). Infection of the affected tissue may lead to a septic shock
How is Arterial Embolism Treated?
The treatment of Arterial Embolism depends on the site of the blockage. The two most important organs, where a blockage can cause serious injury, are the heart and brain - where it can cause a heart attack and a brain stroke, respectively.
- For a blockage in the coronary arteries, the 2 most common cardiac procedures are coronary angioplasty with stent placement and coronary artery bypass graft surgery. These procedures are performed to help restore blood flow
- Balloon angioplasty is an intervention to widen the narrowed arteries of the heart. The interventional cardiologist threads a balloon-tipped catheter into the obstructed artery and inflates it, flattening the plaque against the arterial wall
- Coronary artery bypass graft surgery is performed, to reroute or bypass the blood flow, around the clogged coronary artery
- Aspirin lowers mortality and it is critical to administer it, as early as possible
- Clopidogrel helps keep platelets from clumping together and forming clots. It has been shown to decrease the death rates, due to heart attack or stroke. Clopidogrel is indicated, when the patient has an intolerance of aspirin, or has undergone angioplasty with stenting
- Heparin will prevent clots from forming in the coronary arteries. However, it does not dissolve clots that have already formed
- Thrombolytics, such as streptokinase, alteplase, reteplase, and tenecteplase, can dissolve clots
- Pain killers may be administered to reduce the pain
- Treatment may include measures to lower one’s blood pressure and cholesterol levels
How can Arterial Embolism be Prevented?
- Arterial Embolism can be prevented with lifestyle modifications, including a diet, which is low in saturated fat. A decreased cholesterol intake and increased intake of soluble fiber is recommended
- Avoid smoking, for it increases the risk of a stroke
- Begin a program of regular exercise, such as walking, after consultation with your healthcare provider. Regular exercising can help improve your blood circulation and help lose any additional weight
- Antiplatelet drug therapy may be prescribed by the physician, to help protect against a future stroke or heart attack
- Have your blood pressure and cholesterol levels checked regularly by your physician, and keep them under constant control
What is the Prognosis of Arterial Embolism? (Outcomes/Resolutions)
- The prognosis of Arterial Embolism depends on the location of the clot and the severity of the block. Currently, excellent treatment measures are available that save lives and avoid long-term complications
- Treatment measures, such as the use of thrombolytics or aspirin, performing an angioplasty procedure, have led to significant decrease in the risk of deaths, from heart attack. Many patients are seen to have a normal quality of life, after a heart attack or a heart failure
- An amputation may have to be performed, if there is an irreversible damage to the artery of the arm or leg, leading to necrosis or gangrene formation in the arm or leg
- There is always a risk of recurrence with Arterial Embolism
Additional and Relevant Useful Information for Arterial Embolism:
- Arterial Embolism can cause a heart attack, or lead to a stroke. Occurrence of an episode of Arterial Embolism can have long-term health consequences, if appropriate treatment measures with close follow-up checkups are not instituted.
- Studies have shown that an individual, who has suffered a heart attack, has a 3-4 times greater chance of a brain stroke. Also, an episode of heart attack increases an individual’s risk of getting a future heart attack, by a factor of about 5-7.
The following article links will help you understand brain stroke, heart attack, atherosclerosis, and coronary angioplasty procedure.