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Cardioembolic Stroke Secondary to Massive Stress-Induced Apical Thrombosis: A Clinical Conundrum Relating to

Siva N S Yarrarapu1, Parth Shah2, Vikramaditya S Venkata3

  • 1Department of Internal Medicine, Monmouth Medical Center/RWJBH, Long Branch, NJ, USA.

Journal of Community Hospital Internal Medicine Perspectives
|October 23, 2023
PubMed

Insights

Takotsubo cardiomyopathy, a stress-induced heart condition, can lead to left ventricular thrombus and stroke. This case presents a treatment dilemma, balancing anticoagulation for thrombus against contraindications for stroke.

Area of Science:

  • Cardiology
  • Neurology

Background:

  • Takotsubo cardiomyopathy (TTC), or stress cardiomyopathy, involves transient left ventricular dysfunction without coronary artery disease, often triggered by stress.
  • It is linked to catecholamine excess or endothelial dysfunction, potentially causing serious complications.
  • Left ventricular thrombus formation occurs in 5-14% of TTC patients, increasing the risk of thromboembolic events like stroke.

Observation:

  • This report details a case of TTC with an apical left ventricular thrombus.
  • The patient experienced a significant cardioembolic stroke secondary to the thrombus.

Findings:

  • The case highlights a clinical challenge: the need for anticoagulation to manage the left ventricular thrombus.
  • Simultaneously, the severe ischemic stroke contraindicates immediate anticoagulation, creating a therapeutic dilemma.

Implications:

  • This case underscores the complex management of TTC complications, particularly the interplay between cardiac thrombus and ischemic stroke.
  • It emphasizes the need for careful consideration of anticoagulation strategies in such scenarios.
  • Further research may clarify optimal treatment pathways for patients with TTC, LV thrombus, and stroke.

Keywords:
AnticoagulationCardioembolic strokeLeft ventricle thrombusStress cardiomyopathyTakotsubo cardiomyopathy

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