Arterial embolism (acute occlusion)

The same mechanism all at once instead of over years: the most violent belly pain with a soft belly, often with atrial fibrillation. Here hours decide — the chronic form, by contrast, develops over months.

With a suddenly pale, cold, painful leg or arm without a pulse every hour counts. Do not eat or drink — treatment often follows straight away.

Let the leg hang rather than raising it, so some blood still arrives. Do not use a hot water bottle or a hot bath: warmth raises the tissue’s demand, which the blood cannot meet just now.

The clot came from somewhere — usually from a fibrillating atrium, less often from the aorta or from the heart after an infarction. Without that answer the event repeats.

Anyone who recognises an irregular pulse at the wrist often finds atrial fibrillation before it forms a clot. Two minutes in the morning are enough.

After the event it is about lasting blood thinning that matches the source, and about control of blood pressure, sugar, fats and smoking. Those five points decide the second time.

Heparin is given at once so the clot does not grow — it does not dissolve it. What removes the blockage is retrieval with a catheter or surgery, and there hours count: nerves tolerate about four to six hours without circulation, muscle a little longer. Then the search for the source follows, almost always the heart in atrial fibrillation — without lasting anticoagulation the next blockage comes. Warming and elevating are wrong here: the leg is kept low.

Six signs lead to the diagnosis, all beginning with P: pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold — the more of them, the more urgent. Nerves tolerate about four to six hours without circulation, muscle six to eight, skin considerably longer. So the time window decides. In about eight out of ten the clot comes from the heart, usually in atrial fibrillation. After reopening, reperfusion syndrome is watched for: potassium and kidney values rise within hours.

Acute limb ischaemia — every hour counts, call at once. Common source: atrial fibrillation (hence anticoagulation there).

Rises when muscle tissue dies without blood supply. The value does not measure the blockage but the damage — and urges haste.

Is released from the damaged tissue after the vessel is reopened and is then dangerous for the heart rhythm.

The breakdown of muscle burdens the kidneys. So a lot of fluid is given and this value is followed closely.

The commonest source is a clot from the heart in atrial fibrillation. So it is always about protection against the next event as well.

They lower the blood fats and act on the excitability of the heart muscle. Oily sea fish twice a week is the best-supported route; very high doses from capsules are not a harmless more.

Keeps the rhythm steady and lowers blood pressure. Water tablets drive it down, certain blood pressure drugs and a weak kidney drive it up — which is why it is checked under treatment.

A lack favours extra beats and at the same time keeps a potassium deficiency going. Anyone replacing only the potassium sees no success while the magnesium is missing.

Less salt lowers blood pressure measurably, and most of it is not in the salt cellar but in bread, cheese, cured meat and ready meals. With very low blood pressure the opposite applies.

Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

The most common source of a sudden vessel blockage is atrial fibrillation — and an overactive thyroid is one of the few fixable reasons for it. After an embolism TSH therefore belongs to the search for the cause.

On warfarin-type blood thinners vitamin K is the counterpart — eating steadily matters more than eating little. Vitamin D, by contrast, does not influence clotting and is often mixed up with it here.

An occlusion shows that clots form. A Mediterranean pattern with olive oil, fish, pulses and vegetables is the best-studied frame for preventing further vascular events.

After a vessel occlusion it is about the vessels as a whole. The Mediterranean pattern is the best-studied frame for preventing further events.