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 Complications
Intracardiac 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
Causes & Risk Factors
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:
Scarring from a previous heart attack
Other types of cardiomyopathy, such as left ventricular non-compaction, hypertrophic cardiomyopathy, and Chagas cardiomyopathy
Presence of foreign material, such as a pacemaker lead or prosthetic heart valve
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
Emergency Coronary Thrombosis Symptoms
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:
Palpitations or irregular heartbeat
Difficulty exercising
Shortness of breath
Lightheadedness or dizziness
Tiredness
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
Treatment for Blood Clot in the Heart
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 Recover
In 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) Considerations
After 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
Getting enough good quality sleep
Managing weight
Controlling blood sugar
Long-Term Monitoring After Blood Clot in Heart
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
Summary
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.
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