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Mesenteric ischemia following large left ventricular fibroid thrombosis due to myocardial infarction: A case report
Ali Azari1, Omidreza Amini2, Rasool Lakziyan3
1Department of Cardiac Surgery, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
This case report details a myocardial infarction complicated by left ventricular thrombosis, emphasizing prompt diagnosis and surgical intervention for this serious condition.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Left ventricular thrombosis (LVT) is a recognized complication of acute myocardial infarction (AMI), particularly anterior ST-elevation myocardial infarction (STEMI).
- LVT often occurs in the presence of apical akinesis and dyskinesia, increasing embolic risk.
Observation:
- A 45-year-old male presented with symptoms suggestive of myocardial infarction, including epigastric pain, fever, and tachycardia.
- Echocardiography revealed a large, mobile left ventricular thrombus (1.7 x 1.9 cm²) with reduced ejection fraction (40%).
- The patient developed mesenteric ischemia during hospitalization, a potential complication of embolic events.
Findings:
- Electrocardiography showed Q waves and biphasic T waves indicative of myocardial injury.
- Emergency open cardiac surgery successfully removed the left ventricular thrombus via sternotomy and ventriculotomy.
- Despite surgical removal, the patient experienced mesenteric ischemia, highlighting the complexity of LVT management.
Implications:
- This case underscores the critical need for timely diagnosis and management of left ventricular thrombosis following myocardial infarction.
- Early detection and intervention are crucial to prevent severe complications such as systemic embolization and organ ischemia.
- Effective treatment strategies for LVT require a multidisciplinary approach, integrating cardiology, cardiac surgery, and intensive care.
Introduction:
Left ventricular thrombosis is a common complication of acute myocardial infarction, usually occurring after anterior ST-elevation myocardial infarction, akinesis, and extensive dyskinesia of the apex, anterolateral, or anteroseptal. In this article, we report a case of myocardial infarction with left ventricular thrombosis.
Case Presentation:
A 45-year-old man was referred to our hospital with complaints of severe epigastric pain, sweating, fever, and tachycardia. In laboratory tests, findings for triose phosphate isomerase enzyme were negative, but on electrocardiography, the Q wave in the V1 and V2 leads and the biphasic T wave in the V2, V3, and V4 leads were evident. In Akinesian echocardiography, apical segmentation with a large organic, mobile, pedunculated thrombosis measuring 1.7 × 1.9 cm2 and an ejection fraction of 40% were reported. The patient then underwent emergency open cardiac surgery through a central sternotomy to remove the thrombosis.
Clinical Discussion:
The clinical manifestations of left ventricular thrombosis include cerebral thromboembolism and systemic distal embolization, which are dangerous despite surgery. The echocardiography revealed that the left ventricular keratosis had been surgically removed through ventriculotomy. The patient experienced mesenteric ischemia during hospitalization, and due to the initial presentation of severe abdominal pain, it is not uncommon for the patient to be diagnosed with mesenteric ischemia before referral. The patient had the following vital signs: SPO2, 98%; BP, 96/63; PR, 91; RR, 19; and GCS, 10/15 and was treated in the intensive care unit.
Conclusion:
Our case highlights the importance of diagnosis and on-time treatment of post-large left ventricular fibroid thrombosis complications.
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