Coronary Thrombosis: Causes, Risk Factors, Prevention, and Emergency Response

Coronary thrombosis occurs when a blood clot (thrombus) forms inside a coronary artery, blocking blood flow to the heart muscle. It is the primary mechanism behind most acute myocardial infarctions (heart attacks).

Pathophysiology

Rupture of an atherosclerotic plaque exposes thrombogenic material—such as collagen and tissue factor—to circulating platelets, triggering clot formation. The resulting thrombus may partially or completely occlude the arterial lumen.

Major Risk Factors

• Modifiable: Hypertension, dyslipidemia (high LDL, low HDL), smoking, diabetes, obesity, sedentary lifestyle, poor diet, chronic stress.
• Non-modifiable: Age, male sex (pre-menopause), family history of premature coronary artery disease, genetic hyperlipidemias.
• Emerging: Inflammatory markers (hs-CRP), lipoprotein(a), sleep apnea, chronic kidney disease.

Prevention Strategies

1. Lifestyle: Adopt a Mediterranean diet, engage in at least 150 minutes of moderate exercise weekly, quit smoking, and maintain a healthy weight.
2. Medical management: Statin therapy per guidelines, blood pressure control (<130/80 mmHg), antiplatelet therapy (e.g., aspirin) for selected primary or secondary prevention, and optimal diabetes management.
3. Screening: Regular lipid panel, glucose/HbA1c, blood pressure checks, and ASCVD risk calculation (e.g., Pooled Cohort Equations).

Emergency Recognition

Symptoms include chest pressure or pain (may radiate to arm, jaw, or back), shortness of breath, cold sweats, nausea, and lightheadedness. Call emergency services immediately. Early reperfusion—via percutaneous coronary intervention (PCI) or thrombolytics—saves heart muscle and lives.