Vital Signs, Biomarkers, Oxyhemoglobin and Carboxyhemoglobin

Vital signs are signs of life that guide doctors as they take care of patients. The original vital signs of temperature, pulse, and respiration provide snap shots of human physiology that are worth thousands of words.

Modern vital signs include holter electrocardiogram (ECG), pulse oximeter that measures oxyhemoglogin and carboxyhemoglobin, capnogram that measures exhaled carbon dioxide (ETCO2), and acoustic respiration. Computer vital signs record videos of human physiology that are worth millions of words.

Biomarkers are part of vital signs that change during illness. For example, carboxyhemoglobin, which is carbon monoxide in blood, increases during abnormal anaerobic metabolism that causes acidosis.

Carboxyhemoglobin (SpCO) is a circulating biomarker that increases in the extremities of patients with acidosis that causes peripheral neuropathy and DVT formation.

Venous Blood Clot Life Cycle: DVT, VTE, PE

This website focuses on blood clots, which are variable in composition and follow repeating life cycles.

Solid or semisolid clots start as DVT (deep vein thrombosis) inside muscles, which causes inflammation. Next, pieces of DVT break loose during walking or exercise and migrate into the heart as VTE (venous thromboembolism). VTE inside the right heart (thrombodextracardia) cause palpitations with premature heartbeats. Finally, clots stop in the lungs as PE (pulmonary embolism), where they interfere with breathing, cause hot flash fever, and desaturation events with panic attacks.

Leonardo da Vinci: focus on the Gestalt 

Blood clots are the natural glue made by our body to stop bleeding due to injury. Cancer, germ infections, bad circulation from obesity, or decreased blood flow from sitting also cause blood clots. When pieces of blood clots break loose from sore veins and migrate into the heart, they cause palpitations with premature beats of the heart.

Blood Clots in the Pulmonary Valve: Pulsus Interruptus

Leonardo believed in taking time to focus his attention and use his imagination. Blood clots cause the heart to skip a beat when they pass through the pulmonary valve, which has three leaflets.

Imagine what goes on inside the heart when an elongated tubular clot (VTE) moves into the valve. Visualize the buildup of pressure inside the right ventricular outflow tract (RVOT) as the nose of a blood clot reduces blood flow through the valve. Suddenly the pressure in the RVOT triggers a protective heartbeat called PVC (premature ventricular contraction).

The PVC prevents dangerous stretching of the ventricle that causes sudden fatal fibrillation. PVC is an automatic protective reflex that prevents sudden death!
 

Premature Ventricular Contractions: Pulsus Interruptus

Think about what happens to the heartbeat during 130 milliseconds as a torpedo-shaped sticky purple blood clot about the size of a small golf pencil passes in and out of the pulmonary valve.

Blood clots narrow the opening and reduce blood flow as the nose of the clot enters the valve. A small clot has a big effect on blood flow through the valve because a 20% reduction of the valve size reduces blood flow by 50%. Clots cause premature increase of pressure inside the outflow tract of the right ventricle (RVOT) and myofibrils in the RVOT contain intrinsic pacemaker cells, which become excited when they are stretched. RVOT pacemaker cells start premature protective ventricular contractions, which prevent sudden overload and stretching of the right ventricle.

A premature right ventricular contraction causes the valve to close and grip the nose of the clot, which causes the right ventricle to develop a rotating isometric contraction that tears open the neck of the clot.

The right ventricle is intimately connected to the left ventricle by a common wall, and blood clots in the pulmonary valve prevent BOTH right and left ventricles from contracting. The right ventricle dilates as the left ventricle partly decompresses and the heart skips a pulse as it contracts without pumping blood (pulsus interruptus).

After the clot passes through the pulmonary valve, the right ventricle decompresses and pumps a increased volume; and the heart flops back to the right as both ventricles empty. Clots cause PVC with powerful flip-flop palpitaions and skipped heartbeats.

Think about how the parts are connected and take time to use your imagination

• Small blood clots cause the heart to skip one beat
• Elongated clots cause the heart to skip every other beat
• Clots cause flip-flop palpitations as they pass through the pulmonary valve
• Large clots in the pulmonary valve cause the heart to skip consecutive beats
• Short runs of consecutive skipped beats lead to fainting spells (v-tach)
• Long runs of skipped beats cause unconscious anoxic convulsions
• Unconscious seizures perform self-CPR
• Tonic clonic contractions by the arms and legs pump blood into the right ventricle
• Pulsating thrusts of blood expel clots stuck in the pulmonary valve
• Convulsions expel clots that obstruct the pulmonary valve
• Epileptic CPR performs the 'Heimlich' maneuver on an obstructed pulmonary valve
• Self-CPR restores blood flow into the lungs
• Successful CPR reanimates someone suffering thrombocardiac arrest

Grand Mal Epilepsy, CPR, and Sudden Unexpected Death

Large sticky purple blood clots inside the heart block the outflow of blood at the pulmonary valve. This is thrombocardiac arrest, which causes continuous skipped heartbeats (pulsus interruptus) and stops blood flow into the lungs and brain.

Lack of brain blood flow cause cerebral acidosis that triggers unconscious grand mal convulsions. Rhythmic contractions of the arms and legs pump blood into the right ventricle of the heart; and repeating pulsating thrusts of blood perform the Heimlich maneuver on the obstructed pulmonary valve.

Epileptic convulsions perform unconscious self-CPR (cardiopulmonary resuscitation). This restores blood flow into the lungs and brain, which reanimates an epileptic patient suffering from a sudden thrombocardiac arrest. Failure to expel clots out of the obstructed valve leads to Sudden Unexpected Death in Epilepsy (SUDEP).

Gestalt

Thrombophysiology involves metabolism, circulation, and respiration. It will melt your brain if you think of everything at once, so take your time and focus on one thing until it becomes familiar. Next, look at something else. Gradually 'see' the whole picture, which is the Gestalt.

Venous clots are variable and include a mixture of liquid glue (detritus) and semisolid or solid thrombus. Solid clots in the heart cause skipped beats, while liquid glue (detritus) clogs up pulmonary alveoli, which causes wheezing, panic attacks or rare anaphylactic suffocation.

Not everyone can go to medical school, but most people can figure out that solid purple clots in the heart lead to fainting spells or unconscious grand mal epileptic seizures. Moreover, liquid glue (detritus) in the lungs causes wheezing with panic attacks.

Please take time to 'see' the Gestalt and find joy in your journey as you learn more about blood clots and the protective mechanisms that prevent sudden death.