1
|
Manasrah N, Abdel-Qader A, Al Sbihi A, Alqasem S, Saif LT, Chaudhary AJ, Ismail R, Rajagopal R. Left Ventricular Thrombus Formation in a Structurally and Functionally Normal Heart: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2022; 10:23247096221101852. [PMID: 35619244 PMCID: PMC9150229 DOI: 10.1177/23247096221101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/17/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
Left ventricular (LV) thrombosis usually occurs as a complication of acute anterior myocardial infarction (MI) and dilated cardiomyopathy. It also occurs in patients with a hypercoagulable state. However, in the setting of normal systolic function, LV thrombi are extremely rare. We present a case of a healthy woman who had LV thrombus despite normal LV systolic function that presented as an acute aortoiliac embolism.
Collapse
Affiliation(s)
| | - Anas Abdel-Qader
- DMC Sinai-Grace Hospital, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Ali Al Sbihi
- DMC Sinai-Grace Hospital, MI, USA
- Wayne State University, Detroit, MI, USA
| | | | | | - Ahmed J. Chaudhary
- DMC Sinai-Grace Hospital, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Rana Ismail
- DMC Sinai-Grace Hospital, MI, USA
- Wayne State University, Detroit, MI, USA
| | | |
Collapse
|
2
|
Svendsen C, Pauley E, Falk K, Weickert T, Yeung M, Stouffer GA. Patients with Left Ventricular Thrombus Despite Normal Systolic Function. Am J Med Sci 2021; 362:198-206. [PMID: 34172202 DOI: 10.1016/j.amjms.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
The formation of a thrombus in the left ventricle (LV) in patients with normal systolic function is very rare. We report a case and identified 31 other adult patients who had an LV thrombus with normal LV systolic function. The median (IQR) age of these patients was 43 [37,59] years with a slight male predominance (59%). The vast majority of patients presented with embolic complications (28; 88%) with 3 of the other patients presenting with a febrile illness. Most of the cases occurred in the setting of an identifiable medical condition that carries an increased risk of thrombosis including inflammatory diseases, malignancies or hypereosinophilia. Treatment generally included anticoagulation with or without surgical removal or systemic thrombolysis. Recurrence of LV thrombus and/or embolic events have been reported in patients with LV thrombus and normal LV systolic function suggesting that long term anticoagulation may be needed.
Collapse
Affiliation(s)
- Christopher Svendsen
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, NC, United States
| | - Eric Pauley
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Kristine Falk
- The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, United States
| | - Thelsa Weickert
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Michael Yeung
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States; The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, United States.
| |
Collapse
|
3
|
Grewal HK, Bansal M, Garg A, Kasliwal RR, Bhan A, Gautam D. Left Ventricular Thrombus and Cardioembolic Stroke in a Patient with Ulcerative Colitis: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 9:67-70. [PMID: 33519347 PMCID: PMC7839577 DOI: 10.4103/sjmms.sjmms_525_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/16/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022]
Abstract
Left ventricular (LV) thrombi usually occur in the setting of global or regional LV systolic dysfunction and are extremely rare in the absence of LV wall motion abnormalities. We report here a case of a 23-year-old female who presented with cardioembolic stroke due to ulcerative colitis. To determine the cause of stroke, several investigations and evaluations were carried out, but the results were mostly normal or unremarkable. Transthoracic echocardiography revealed an oscillating pedunculated globular mass, which was eventually resected due to recurrent transient ischemic attacks. The histopathology of the excised mass revealed it to be an organized thrombus with acute and chronic inflammatory cells and fibroblasts. The uncommon etiology combined with the unusual appearance of the thrombus presented a major diagnostic and therapeutic dilemma for this exceedingly rare cause for intracardiac thrombus formation. Therefore, it would be useful to have a low threshold for screening patients with active inflammatory bowel disease for possible ventricular thrombosis before discharge, especially if other risk factors are present.
Collapse
Affiliation(s)
- Hardeep Kaur Grewal
- Department of Clinical and Preventive Cardiology, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Manish Bansal
- Department of Clinical and Preventive Cardiology, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Arun Garg
- Department of Neurology, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Ravi R Kasliwal
- Department of Clinical and Preventive Cardiology, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Anil Bhan
- Department of Cardiac Surgery, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Dheeraj Gautam
- Department of Laboratory Medicine, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India
| |
Collapse
|
4
|
Leow AST, Sia CH, Tan BYQ, Chan MYY, Loh JPY. Long-Term Outcomes and Recurrence of Left Ventricular Thrombus After Anticoagulation. J Am Coll Cardiol 2020; 76:484-486. [DOI: 10.1016/j.jacc.2020.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
|
5
|
Svendsen C, Pauley E, Stouffer GA. Left Ventricular Thrombus Formation in the Setting of Normal Systolic Function. JACC Case Rep 2020; 2:1470-1474. [PMID: 34316999 PMCID: PMC8302091 DOI: 10.1016/j.jaccas.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/26/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Abstract
We describe the case of a 42-year-old female with recurrent left ventricular (LV) thrombus and multiple embolic events despite having normal LV systolic function. The clinical presentation, associated conditions, diagnostic evaluation and treatment of patients with LV thrombus in the setting of normal LV systolic function are discussed. (Level of Difficulty: Beginner.)
Collapse
Affiliation(s)
- Christopher Svendsen
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina
| | - Eric Pauley
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.,McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
6
|
Abstract
Inflammatory bowel disease is closely associated with an increased risk for thrombotic events. Thrombosis mostly occurs in the extremities, lungs, and liver; but it can also occur in the ventricles of the heart. The primary goal of this article is to increase awareness of the risk for ventricular thrombosis in this patient population among healthcare professionals and, thus, appropriate prompt use of thromboprophylaxis therapy for these patients during acute flare-ups. Early diagnosis and intervention are critical for ventricular thrombosis to prevent systemic embolisation of the thrombus. Concisely, inflammatory bowel disease predisposes to the development of thrombi. A low threshold for the use of imaging studies to detect such thrombi is warranted.
Collapse
|
7
|
Rasalingam R, Saeed IM, Woodard PK, Pérez JE. Left Ventricular Thrombus in the Setting of Normal Left Ventricular Function in Patients with Crohn's Disease. Echocardiography 2015; 33:145-9. [DOI: 10.1111/echo.13081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ravi Rasalingam
- Division of Cardiology; Boston Veteran Affairs Medical Center; Boston Massachusetts
| | - Ibrahim M. Saeed
- Division of Cardiology; St. Luke's Mid America Heart Institute Cardiac Consultants; Kansas City Missouri
- Univeristy of Missouri; Kansas City; Missouri
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology; Washington University in St. Louis; St. Louis Missouri
| | - Julio E. Pérez
- Division of Cardiovascular Disease; Washington University in St. Louis; St. Louis Missouri
| |
Collapse
|