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[A case of hypertrophic obstructive cardiomyopathy with left atrial giant thrombus during anti-platelet therapy]
Insights
A rare case of a giant left atrial thrombus in hypertrophic obstructive cardiomyopathy is presented. This uncommon condition, complicated by atrial fibrillation and heart dysfunction, resisted urokinase treatment, highlighting diagnostic and therapeutic challenges.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Internal Medicine
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) can present with complex intracardiac complications.
- Left atrial giant thrombus formation is an exceptionally rare event, often associated with significant cardiovascular compromise.
Observation:
- A 77-year-old female with HOCM developed a large left atrial thrombus despite antiplatelet therapy.
- Diagnosis was confirmed using echocardiography and contrast-enhanced computed tomography.
- The patient had coexisting atrial fibrillation, low cardiac output, left atrial enlargement, and diastolic dysfunction.
Findings:
- The patient's complex cardiac condition was deemed the primary predisposing factor for thrombus formation.
- Surgical intervention was contraindicated due to the patient's poor clinical status.
- Urokinase therapy was unsuccessful, likely due to the organized nature of the thrombus.
Implications:
- This case underscores the rarity and diagnostic challenges of giant left atrial thrombi in HOCM.
- The findings suggest that organized thrombi may be refractory to thrombolytic therapy.
- Further research into optimal management strategies for such rare cardiovascular presentations is warranted.
Abstract:
A case of a 77-year-old female with hypertrophic obstructive cardiomyopathy having the left atrial "giant" thrombus was reported; the diagnosis of the localization and size of the thrombus was made by employing echocardiography and contrast enhancement computed tomography as well. The clinical record indicated that the thrombus formation, which happened in the course of the antiplatelet therapy, was to be considered due to the complicated condition of the patient, i.e., the combination of atrial fibrillation, low cardiac output, enlargement of left atrium and left ventricular diastolic disfunction, which assumed to predispose the giant thrombus. Avoiding the surgical removal of the thrombus because of the poor conditions of the patient, urokinase treatment was attempted, but not successful, which might be derived from the nature of the thrombus already organized. In general, left atrial giant thrombus is very uncommon status; if any, it is occasionally complicated with mitral stenosis. The case reported deems to be very rare, enough worthy to be reported.