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Intracardiac thrombus and Murphy's law: Reflections on a clinical dilemma

Patrícia Rodrigues1, Maria João Sousa1, Luísa Caiado1

  • 1Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|March 20, 2016
PubMed

Insights

A patient with left ventricular systolic dysfunction experienced systemic embolization despite anticoagulation for apical thrombus. This case highlights the need for tailored treatment strategies for intracardiac thrombus with high embolic risk.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Thrombosis Research

Background:

  • Left ventricular systolic dysfunction (LVSD) is a significant cardiovascular condition.
  • Intracardiac thrombus formation, particularly apical thrombus, is a known complication of LVSD.
  • Systemic embolization from intracardiac thrombus poses a severe risk of morbidity and mortality.

Observation:

  • A 49-year-old patient with LVSD presented with a large, mobile, and protruding apical thrombus.
  • Despite receiving anticoagulation therapy, the patient experienced extensive and clearly defined systemic embolization.
  • The clinical course underscored the limitations of standard anticoagulation in preventing embolization in high-risk cases.

Findings:

  • The case demonstrates a challenging clinical scenario where anticoagulation alone was insufficient to prevent systemic embolization from a high-risk apical thrombus.
  • Evidence regarding the optimal management of intracardiac thrombi with significant embolic potential is reviewed.
  • A tailored therapeutic approach is proposed to mitigate the risk of catastrophic embolic events.

Implications:

  • This case emphasizes the critical need for individualized treatment strategies for patients with intracardiac thrombus and high embolic risk.
  • Early consideration of alternative or adjunctive therapies beyond anticoagulation may be warranted.
  • Improved management protocols could potentially reduce the incidence of severe embolic complications in cardiovascular patients.

Keywords:
AnticoagulationAnticoagulaçãoEmbolizationEmbolizaçãoLeft ventricular thrombusThrombectomyTrombectomiaTrombo do ventrículo esquerdo

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