Embolisms

Today I'm writing about embolisms. An embolism is a nice way of saying there is a chunk of something traveling through your blood stream. Embolisms can occur through several different mechanisms. They can be tiny clots of blood (medically known as a "thrombus"), little pieces of fat, or rarely, air bubbles.


A)The embolism begins its journey. The embolism can occur due to many reasons. When a clot/thrombus occurs in the arms or legs it is known as a DVT (Deep Vein Thrombosis). Usually due to some sort of compromise in the circulation. There have been cases of this reported after long airplane rides. If you smoke and/or are obese you are much more likely to have these spontaneously occur. If you break a limb, little pieces of fat can cause an embolism.

B)The embolism passes through the right side of the heart and travels to the lungs.

C)The embolism (clot/piece of fat) gets caught in the microscopic blood vessels of the lungs. At this point, you're looking at a Pulmonary Embolism.

Fortunately, the blood vessels of the lungs are so small that the embolism will become lodged there and travel no further. Unfortunately, a pulmonary embolism is painful and makes it difficult to breath. Untreated, the odds of dying are about 30%.

All this from a microscopic object no bigger than the size of a pinhead!

One out of the four people in the world have a heart condition called a patent foramen ovale. This is a small hole leftover from birth that allows a small amount of blood to pass between the right and left side of the heart, skipping the lungs altogether. Normally this hole in the heart is no big deal, since it doesn't cause any symptoms.

But if you're REALLY unlucky, and happen to have a patent foramen ovale, then there is a small chance the embolism will slip through this hole. When that happens, the embolism is free to travel to the arteries of the heart, causing a heart attack, or to the brain, causing a stroke. If this happens, your chances of survival drop dramatically.

"OMG How do I stop this from happening to me?"
#1 Exercise and you don't have to do aerobics just go for a walk and get your blood circulating
#2 Eat a balanced diet and don't be fat
#3 If you smoke, stop.

Now if you end up in the hospital for some reason you'll notice a few things.
A) you'll probably have weird boots on your legs that are hooked up to a machine that inflate and deflate the boots. The purpose of this is to simulate walking and to stimulate blood circulation. Yes, they are annoying, but wear them.
B) You're going to get shots in your stomach. These shots will be either Heparin, Lovenox, or Fragmin. The keyword here is "prophylaxis." Its kind of like wearing a condom. The purpose of the shots are to prevent your ass from getting a blood clot that at the least will make you miserable and at the most kill you.
C) People are going to try and make you get out of bed and walk. Don't be a puss. Get some exercise. Even if you're just getting up and walking to the bathroom and back. You need to get your ass out of bed as often as possible.

Oh no, I have or think I have a DVT or embolism! What to do???
A)First of all, go to a hospital. Now. No, stop reading this. Don't drive yourself there, and don't have someone else drive you. Call an ambulance. Seriously, stop reading this. Do it now. If you're already there, then great!
B)You're going to be put on a heparin drip through an IV. This is a more aggressive version of the shots in the belly. Heparin will not get rid of the clot, this is a common misconception. The purpose of the heparin is to stop the clot from getting any bigger and killing you.
C)You'll be having your blood drawn a lot. This is to monitor the heparin therapy you're receiving, amongst other things. Heparin is wonderful but if you are too anticoagulated then you might start bleeding out of random orifices like your eyes ears or butt. At worst, a blood vessel in your brain could burst, and then you will die or be tarded. So don't be a jerk about getting getting your blood drawn. No one in the world likes needles.
D)You're going to have to start on a long term anticoagulant therapy (probably something you'll need to be taking for the rest of your life, btw). Most likely a drug called warfarin (aka coumadin) - cuz its cheap. Later on down the road you might get switched to aspirin, but lets not get ahead of ourselves. You'll probably wonder why they're giving you coumadin on top of the heparin? Because coumadin takes a few days to start working, and the dose will need to be adjusted to prevent the aforementioned random bleeding problems.