Massive biventricular thrombi complicating new-onset heart failure in a patient with suspected COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Hematology

Background:

• The World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic, caused by SARS-CoV-2.
• COVID-19 presents a significant threat due to risks of microvascular, venous, and arterial thrombosis, worsening organ injury and mortality.
• While the precise mechanisms linking SARS-CoV-2 to thromboembolism and myocardial injury are unclear, COVID-19-induced hypercoagulation is recognized as a contributor to disease fatality.

Observation:

• This report details a patient with extensive biventricular thrombi and new-onset severe systolic dysfunction, an unusual and severe manifestation of COVID-19.
• The patient presented with a right atrial "clot in transit" from deep vein thrombosis (DVT) and a muralized biventricular thrombus secondary to global hypokinesis.
• This presentation is attributed to the hypercoagulable state induced by COVID-19 infection, compounded by severe systolic dysfunction.

Findings:

• The study identifies extensive de-novo intracardiac thrombus formation as a previously unreported complication of COVID-19.
• This case demonstrates a correlation between COVID-19-related hypercoagulable state, cardiac injury, and the development of intracardiac thrombus and severe systolic dysfunction.
• Such severe thrombotic and cardiac complications can occur even in younger patients without pre-existing cardiovascular comorbidities.

Implications:

• Increased awareness of severe thrombosis and cardiac failure as potential initial presentations of SARS-CoV-2 infection is crucial.
• Strategies for thrombosis prevention are critical given the association between thrombotic manifestations and high COVID-19 mortality rates.
• This case underscores the importance of considering cardiac complications in patients with COVID-19, particularly those with hypercoagulable states.