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Massive Right Heart Thrombus Causing Complete Cardiac Obstruction Relieved by Thrombolysis: A Case Report
Christopher Cy Wong1, John Yiannikas1
1Department of Cardiology, Concord Hospital, University of Sydney, Australia.
European Journal of Case Reports in Internal Medicine
|August 14, 2020
Summary
Right heart thrombus (RHT) can cause sudden cardiac arrest. Rapid diagnosis via bedside echocardiography enables prompt thrombolysis, leading to hemodynamic recovery in critical heart failure cases.
Area of Science:
- Cardiology
- Critical Care Medicine
- Diagnostic Imaging
Background:
- Right heart thrombus (RHT) is linked to acute pulmonary embolism and congestive heart failure.
- Timely diagnosis of RHT is crucial for effective treatment and improved patient outcomes.
Purpose of the Study:
- To highlight the acute presentation of RHT with cardiac arrest.
- To emphasize the role of echocardiography in rapid RHT diagnosis and management.
Main Methods:
- Case report of a 55-year-old male with congestive heart failure and cardiac arrest.
- Initial and bedside transthoracic echocardiography (TTE) to assess cardiac function and identify RV obstruction.
- Intravenous thrombolysis administered following diagnosis of RV thrombus.
Main Results:
- Bedside TTE revealed complete right ventricular (RV) obstruction due to thrombus during cardiac arrest.
- Intravenous thrombolysis resulted in complete thrombus dissolution and rapid hemodynamic recovery within 15 minutes.
- Despite successful thrombolysis, the patient experienced severe hypoxic brain injury and did not survive.
Conclusions:
- Right heart thrombus can present dramatically with cardiac arrest, especially in patients with underlying cardiomyopathy.
- Bedside echocardiography is essential for rapid diagnosis of RHT in emergent settings.
- Thrombolytic therapy can achieve swift thrombus resolution and hemodynamic improvement.
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