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Welcome to Thrombophysiology

The Logical Study of Blood clots


by Dr Bode

 

Do you ever lie awake at night and wonder what makes the heart flip and flop like a fish out of water? Suddenly the heart flutters like a humming bird and then slows down with powerful pounding palpitations that cause hot flashes or night sweats.

Patients with fast fluttering pulses followed by slow strong palpitations frequently develop mysterious brain fog, confusion, weakness, and light-headed dizzy spells.

There is no simple explanation why the heart suddenly beats fast or slow; and not much really matters unless it changes our financial condition or romantic relationships. No one cares too much about the tachy-brady syndrome until they end up in the ICU with a fast / slow heart rate following a long night of drinking and dancing coupled with lack of sleep.

This website presents a new theory that venous blood clots migrate into the heart and interfere with blood flow through the valves. Clots in the valves change the heart rhythm pattern and causes palpitations. Moreover, venous thromboembolism (VTE) in the pulmonary artery squeeze the esophagus, which causes nausea, burping and difficulty swallowing. Burping (thrombo-ructus) while sleeping causes gastroesophageal reflux disease (GERD).

 

 

 DVT and Pulmonary Embolism

In 2005 Dr Bode became sick with a sore restless leg following hernia surgery. A CT scan revealed a blood clot inside the vein beneath the surgical site, and he took blood thinners to dissolve the clot. Later, he used a compression sleeve to squeeze his sore leg because gentle compression eliminates blood clots and prevents the formation of new ones.

Compression of his leg stimulated palpitations, arrhythmias, desaturations, and burping spells. Dr Bode heard heart murmurs with his stethoscope during palpitations. Turning off the compression device stopped the palpitations.Thus, it was easy to conclude that leg compression squeezed tiny mobile clots into the heart, where they caused murmurs at the heart valves. Moreover, clots in the pulmonary artery thumped against the esophagus during the heartbeat, which stimulated nausea and burping.

This website outlines the life cycle of venous blood clots and explains how clots cause problems during their formation, migration, and resolution. 

Thrombophysiology: the study of blood clots

Dr Rudolf Virchow was a German physician who discovered that blood clots in the lungs were the same as blood clots in the legs. He theorized that pieces of clot in the legs broke loose and migrated through the heart into the lungs and called migrating venous blood clots embolia.

Virchow noticed that trauma, stasis, or hypercoagulation led to the formation of venous clots.

Injury, infection, or pregnancy decreases venous blood flow, which decreases tissue oxygen. This lack of oxygen forces cells to develop anaerobic metabolism, which produces metabolic acid. Moreover, cancer cell metabolism is abnormal and produces metabolic acid.

Metabolic acid causes blood proteins to coagulate with red blood cells and platelets to form blood clots. Blood acid burns the lining of veins which become sticky, which causes blood clots to adhere to the inside walls of veins. Blood clots cause phlebitis.   

Life Cycle of Venous Blood Clots

The life cycle of blood clots begins with hemostasis, altered metabolism, and the formation of detritus (liquid bloody glue) followed by thrombus formation called deep venous thromboses (DVT).

Later, pieces of DVT clot break loose and migrate out of sore legs during walking or exercise. Migrating clots become known as venous thromboemboli (VTE), which move into the heart. Sometimes, VTE pass through a congenital hole in the heart and become paradoxical embolim (PDE)  inside the left atrium. PDE cause pain and infarction (tissue death). PDE in coronary arteries cause angina and heart attacks (MI), while cerebral (brain) PDE cause TIAs (transient ischemic attacks) and CVAs (cerebral vascular accidents).

Next, it is theorized that VTE in the heart cause the sick sinus syndrome and GERD.

Finally, VTE move into the lungs where they stop in alveoli and are called pulmonary emboli (PE). Venous blood clots (DVT, PDE, VTE, and PE) cause pathology and change vital signs.

1. DVT (deep venous thrombosis): cause sore, swollen, weak, warm, and red muscles.

2. PDE (paradoxical emoblism) = VTE migrate through PFO into the left atrium and cause ischemia / infarction

3. VTE in the heart (Thrombodextracardia)

  • VTE in the tricuspid valve causes tachycardia with fluttering jugular pulsations
  • VTE in the pulmonary valve causes bradycardia with flip-flop palpitations 
  • VTE in the pulmonary artery causes thrombo ructus, which leads to  GERD.

4. PE: VTE congests lungs, stops oxygen absorption, prevents CO2 exhalation, causes asthma, panic, and narcolepsy.

The heart skips a beat: pulsus interruptus

It is theorized that a semisolid VTE shaped like a torpedo and about the size of a small golf pencil enters the pulmonary valve of the right ventricle. This decreases blood flow out of the right ventricle at the and causes an ECG pattern called bigeminy.

First, as the clot goes through the pulmonary valve, it reduces blood flow out of the right ventricle which causes a premature rise of pressure inside the ventricle, which stimulates a protective premature right ventricular contraction (PVC).

The premature contraction causes the valve to close and grip the nose of the clot as the right ventricle develops an isometric rotating contraction that ruptures the neck of the clot sack. This ruptures the neck of the clot, which releases sticky liquid detritus and decompresses the clot, which reopens blood flow through the pulmonary valve, which allows a normal sinus rhythm (NSR). The heartbeat following PVC pumps extra blood with clot sack and detritus into the pulmonary artery.

Next, the trailing part of the elongated golf pencil shaped clot re-obstructs the valve, which causes a second PVC. The second PVC causes the valve to grip the middle part of the clot, which causes another rotating isometric contraction which extends the rupture of the clot sack towards its tail. This releases more liquid detritus, which decompresses the clot and reopens the valve.

A second strong normal sinus rhythm heartbeat ( NSR) pumps extra blood plus the empty clot sac and detritus into the pulmonary artery, which carries the material into the pulmonary artery and lungs.

The ECG pattern is NSR / PVC / NSR / PVC / NSR as the heart skips every other pulse during an ECG pattern called ventricular bigeminy. 

If you listen to the heart with a stethoscope during bigeminy, you can hear a soft variable systolic murmur at the pulmonary valve as the clot passes through the valve.

Detritus (liquid clot) that is released from the semisolid clot migrates into pulmonary alveoli. PE congests the capillaries of the alveoli, which causes wheezing and difficulty breathing.. Moreover, detritus in the alveoli temporarily stops the absorption of oxygen during inspiration and prevents the exhalation of warm moist vapor full of carbon dioxide during exhalation.

Detritus PE causes desaturation, hypercapnea (elevated carbon dioxide) with narcolepsy, and hyperthermia (fever), which explains the sweating from hot flashes during PMS (premenstrual syndrome) or night sweats in patients with lymphoma.

During bigeminy, the heart flips and flops because the right ventricle enlarges during isometric contractions as the left ventricle partially decompresses by pumping out a small volume of blood. The heart "flips" to the left during PVC and flops back to the right after the clot ruptures, which restores blood flow out of the heart. This is followed by normal sinus rhythm (NSR), which pumps out the ruptured sac plus extra blood and the heart flops back to the right.

The heart repeats its "flip-flop" process during the second PVC, which is followed by a second normal sinus contraction (NSR). Powerful pounding sensations occur because the ventricle pumps with more force to expel clot, debris, and extra blood during NSR that follows PVC.

The pulse slows down as the heart skips every other pulse during bigeminy because the heart contracts isometrically without pumping blood during pulsus interruptus.Thus the pulse rate becomes half of the speed of the ECG rhythm The pulse oximeter records a pulse deficit as the ECG records a non-perfusing PVC.

A Novel  ECG Interpretation: blood flow generates electricity

In 1903 Dr. Einthoven discovered that the heartbeat generates electricity.

Cardiac electrophysiologists explain that cardiac muscle cell depolarization and repolarization events generate the electric potentials of the electrocardiogram (ECG). However, there seems to be a fundamental misunderstanding of the ECG.

In 1977, Eugene Findl and Robert Kurtz published Electrokinetic Potentials in a Left Ventricle/Aorta Simulator. They constructed left ventricle/aorta simulators to evaluate the possibility of generatimg EKG like signals by electrokinetic methodology. According to Findl and Kurtz, "The simulators produced pulsed turbulent flows, simulating mammalian heart pumping conditions. EKG like signals were generated by the motion of the electrolyte through the simulators."

It makes more sense to explain the T wave of the ECG in terms of blood flow generated by the contractions of the aorta and pulmonary artery. In addition, the Q wave can be explained as the downward outward bulging of the conjoint ventricles at the start of systole. Finally, ectopic pacemaker "re-entry" circuits observed inside the left atrium during supraventricular tachycardia (SVT) or atrial fibrillation make more sense if retrograde blood flow into pulmonary veins generates "re-entry" circuits.

 

Blood flow from cardiac contractions generates three separate and distinct electrolyte motion potentials during the heartbeat, and these potentials are the P, QRS, and T waves of the ECG.

First, two atria contract together and generate P wave potentials caused by retrograde flow of blood from the right atrium into the jugular vein.

Next, two ventricles contract together and generate QRS wave potentials caused by blood flow from the left ventricle into the aorta plus blood flow from the right ventricle into the pulmonary artery.

Last, the aorta and pulmonary artery contract together and pump blood, which generates T wave potentials that are mainly caused by blood flow upwards towards the carotid arteries.

Thrombo Arrhythmias:

Blood clots alter blood flow through the heart valves, which alters ECG patterns because blood flow generates the ECG waves, and altering blood flow will change the wave patterns.

Blood clots in the tricuspid valve cause premature atrial contractions, atrial flutter, or atrial fibrillation.

Moreover, blood clots in the pulmonary valve cause premature ventricular contractions (PVCs). Blood clots cause a wide notched QRS as they pass through the pulmonary valve. 

Movever, PDE (paradoxical emoblism) into the RCA (right coronary artery) cause inferior MI (myocardial infarction) that weakens the apex of the conjoint ventricles. This causes a pathological downward outward bulging of the apex of the at the start of systole (takotsubo effect of the 'broken heart syndrome). The downward movement of blood during the start of  ventricular systole explains the Q waves of the QRS of the ECG caused by embolic myocardial infarction.

Finally, pulmonary valve VTE cause the long QT because blood flow out of the pulmonary artery is delayed, which delays and lengthens the T wave of the ECG.

Thrombo Theory Questions & Answers:

  • What makes the heart skip a beat? Pulmonary valve VTE causes PVC's with pulse deficits.
  • How does a solid blood clot (thrombus) cause the heart to skip a beat? It interferes with blood flow through the pulmonary valve, which triggers a protective contraction of the ventricle.
  • What causes blood to form clots? Abnormal metabolism produces acid, which denatures protein, which causes blood to coagulate.
  • Why does abnormal anaerobic (hypoxic) metabolism make lactic acid? Metabolism without oxygen produces metabolic acid.
  • Why does cancer cause clots? Dr Otto Warburg discovered that cancer cell glucose metabolism produced lactic acid, and metabolic acid causes blood clots.
  • Why do runners get clots and PVC's? Dr Otto Meyerhof discovered that anaerobic muscle metabolism produces lactic acid, which causes blood clots, PVCs and palpitations in runners.
  • How does lactic acid activate the blood clotting mechanism? Acid denatures blood proteins, which becomes like velcro. Sticky proteins coagulate with platelets and red cells to form clots.
  • What makes blood clots migrate (embolize) into heart valves? Exercise or walking breaks off pieces of DVT and squeezes them out of sore veins into the heart.
  • What happens to the heart rhythm as clots pass through different heart valves? VTE at the tricuspid valve causes tachcardia and VTE at the pulmonary valve cause bradycardia.
  • Do blood clots cause fluttering or flip flop palpitations? Yes.
  • Why do arrhythmias cause low blood pressure with lightheaded dizzy spells? VTE reduces the ejection fraction, which reduces blood pressure and causes lightheaded dizzy spells.
  • Does partly clotted blood called detritus interfere with breathing? Yes.
  • How do blood clots cause coughing, nausea, gagging and sneezing? VTE inside the pulmonary artery accumulate at the junction where the artery passes in front of the spine. The esophagus touches the back of the heart and pulsating VTE in the artery choke the esophagus causing difficulty swallowing or talking, coughing, gagging, nausea, and sneezing.
  • Do blood clots or detritus cause panic attacks or internal suffocation? Yes.
  • Do blood clots cause pulseless fainting? Yes.
  • How do blood clots cause epileptic seizures? VTE at the pulmonary artery stops the flow of blood into the brain and lungs, which triggers an anoxic convulsions.
  • Do blood clots cause sudden thrombocardiac arrest? Yes, VTE obstruct the pulmonary valve, which stops cardiac output.
  • How does CPR reanimate someone with cardiac arrest without defibrillation? CPR expels clots out of the obstructed valve, which reopens blood flow into the brain and lungs, which reverses acidosis and reanimates someone suffering from sudden thrombocardiac arrest. Early CPR prevents ventricular muscle dilation, which requires powerrful defibrillation to reverse.

Theory of Thrombo Associated Diseases:

  • Cancer → lactic acid → blood clots (Warburg effect)
  • Carbon monoxide poisoning: detritus causes night time hypoxemia → carboxyhemoglobinemia
  • Chronic Fatigue Syndrome
  • Congestive heart failure: right heart failure, valve malfunction, low ejection fraction
  • Exercise-induced asthma: pulmonary embolism (PE) of detritus
  • Fainting spells
  • Gastro esophageal reflux disease (GERD)
  • Infection: anaerobic germ metabolism muscle: glucose → lactic acid → blood clots
  • Injuries: foot, leg, knee, or hip injury → blood clots
  • Headaches: pulmonary detritus ↓ water exhalation → brain edema, headache
  • Insomnia: PE at tricuspid valve → thrombotachycardia → sleep arousal 
  • Macular degeneration: micro emboli
  • Malignant hyperthermia: PE → atelectasis, fever, VTE arrhythmias
  • Migraine headaches
  • Narcolepsy: PE detritus → ↓ exhalation of CO2 → hypercapnea → CO2 narcosis
  • Panic attacks: PE of detritus, desaturation, dyspnea
  • Peripheral neuropathy: venous vascular acidosis → neuropathy, restless leg
  • Pleurisy: PE into alveoli causes sharp ischemic pain
  • Pre-menstrual syndrome: PE of detritus, hot flashes, headache (edema), mild fever
  • Pyriformis syndrome: compartment syndrome, venous acidosis
  • Seizures: VTE at pulmonary valve, sudden hypoxia, convulsions perform CPR
  • Sick Sinus Syndrome: VTE at tricuspid and pulmonary valves
  • Sleep apnea: PE detritus → internal hypercapnea with central CNS depression, central apnea
  • Syncope: short runs of continuous skipped beats, VTE at pulmonary valve
  • Tinnitus: emboli of detritus into sensitive area of inner ear

Theory of Thrombo Symptoms

  • Anxiety, panic attacks
  • Brain Fog
  • Bradycardia
  • Choking
  • Coughing
  • Confusion
  • Depression
  • Dizzy spells
  • Dyspnea (short of breath)
  • Exercise-induced asthma
  • Fainting
  • Fatigue
  • Fear of sudden death
  • Fever: seizure fever, night sweats, hot flashes, malignant hyperthermia
  • Fluttering fast weak jugular palpitations, pulsus reversus
  • Flip-flop pounding slow strong palpitations
  • Gagging
  • Headaches
  • Hot flashes
  • Insomnia with fast racing heartbeats
  • Irregular pulse, pulsus erraticus
  • Irritability
  • Phlebitis
  • Premature beats
  • Light-headed sensations
  • Muscular dystrophy
  • Nausea
  • Night sweats
  • Palpitations
  • Panic Attacks
  • Racing heartbeat
  • Restless leg
  • Seizures / grand mal unconscious convulsions
  • Shortness of breath (dyspnea)
  • Skipped heartbeats
  • Sleep arousal
  • Slow pulse / flip-flop palpitations / skipped heartbeats
  • Sneezing
  • Sudden cardiac arrest syndromes
  • Sore legs
  • Tachycardia
  • Vertigo

Thrombo Diagnosis

  • History: fluttering / flip-flop palpitations, night sweats with racing heartbeats, insomnia, panic attacks with choking, coughing, sneezing with shortness of breath, chronic fatigue, chronic bronchitis, ‘flu’ syndrome, fast weak irregular heartbeat  / slow strong 'pounding' heartbeats, peripheral neuropathy
  • Physical Examination: slow strong ventricular heartbeats mixed with fast weak atrial heartbeats, soft musical grade I – II systolic murmur, mild fever
  • Pulse Oximetry: oxygen desaturation events, elevated peripheral carboxyhemoglobin in sore extremities with phlebitis & peripheral neuropathy
  • Electrocardiogram: premature atrial beats, atrial flutter / fibrillation, premature ventricular beats, tachy-brady / brady-tachy / sick sinus syndrome
  • Echocardiogram: pulmonary valve insufficiency / tricuspid valve regurgitation
  • Arterial Blood Gas (ABG): elevated carbon dioxide saturation (hypercapnea), low oxygen saturation, elevated carboxyhemoglobin
  • Capnography: end tidal expired carbon dioxide (ETCO2) decrease corresponds to oxygen desaturation events (SpO2)

Treatment / Prevention of Bloody Clots

  • Eight hours of rest / sleep every night (decreases metabolic acidosis)
  • Avoid excess drug and alcohol use
  • Maintain adequate water intake, avoid exercise-induced dehydration
  • Diet & Nutrition: control how much and what you eat
  • Moderate aerobic exercise: golf, sex, bowling, gardening, walking, yoga, tai chi
  • Sequential venous compression treats & prevents blood clots
  • Ultrasound: helps resolve inflammation and phlebitis
  • Vibration exercise oscillates bloody clots out of heart valves

What do doctors know about carboxyhemoglobin, the sick sinus syndrome or the long QT?

Thrombodextracardia is a new theory that explains how VTE interfere with blood flow at the triscupid and pulmonary valves, which causes the tachy-brady rhythm of the sick sinus syndrome.

Novel ECG Interpretation: Findl and Kurtz

Blood flow from cardiac contractions generates the electrokinetic potentials of the ECG. Because blood clots alter blood flow, which alters the ECG pattern, the ECG can diagnose blood clots in the heart valves. VTE in the tricuspid valve causes pulsus reversus, PAC, SVT, atrial flutter, and paradoxical atrial fibrillation; while VTE in the pulmonary valve causes PVC, pulsus interruptus, and the long QT.

Novel circulating pH Biomarker:

SpCO (carboxyhemoglobin) identifies extremities with acidosis, which causes DVT formation and peripheral neuropathy with restless leg syndrome.

Thrombo Future: The importance of pulse oximeter / ECG discoveries:

  • Thrombophysiology: hemostasis alters metabolism and produces hemoacidosis
  • Compartment syndrome acidosis causes hemothrombosis (DVT, VTE, potential PDE, & PE)
  • Carboxyhemoglobin locates acidosis and evaluates venous blood flow and neuropathy
  • The pulse oximeter SpCO evaluates DVT therapy
  • Compartment syndrome acidosis causes vascular neuropathy
  • SpCO is a circulating biomarker that evaluates vascular neuropathy and the restless leg syndrome
  • DVT, VTE, PDE, and PE have a life cycle filled with pathological events and altered vital signs
  • Muscle DVT cause inflammation
  • Cardiac VTE cause the sick sinus syndrome and GERD
  • PE of liquid detritus causes desaturation, hypercapnea, narcolepsy and more
  • The ECG can diagnose blood clots in the heart valves
  • VTE in the tricuspid valve cause PAC and pulsus reversus
  • VTE in the pulmonary valve cause PVC and pulsus interruptus
  • Cell phone apps evaluate PVCs and skipped heartbeats
  • Consecutive skipped beats cause fainting, convulsions, and sudden cardiac arrest
  • ECG apps can emit warning signals during consecutive PVC
  • Pulse oximeter cell phone apps can detect desaturation events that lead to narcolepsy
  • Cell phones can emit warning signals during desaturation events that predict narcolepsy
  • Cell phone can detect ECG VTE that cause skipped beats and emit warning signals
  • Cell phones can improve safety by emitting signals of impending fainting episodes
  • We can become happier as brain fog fades away
  • Thank you for your interest and find joy in your journey as you learn more about solid cardiac VTE that cause pulsus interruptus or liquid PE that cause desaturation with narcolepsy
 

 

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