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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Atrial fibrillation-induced cardiomyopathy presenting with bilateral intermittent claudication associated with

Ryoichi Inoue1, Hirotoshi Watanabe2,3, Takahiro Horie1

  • 1Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.

BMJ Case Reports
|March 7, 2024
PubMed

Insights

Asymptomatic atrial fibrillation (AF) can cause left ventricular thrombi and systemic embolism, leading to symptoms like intermittent claudication. Prompt treatment with anticoagulation and amiodarone restored sinus rhythm and improved cardiac function.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Systemic thromboembolism in atrial fibrillation (AF) typically originates from the left atrial appendage.
  • Acute onset is characteristic of AF-related thromboembolic events.

Observation:

  • A woman in her 60s presented with bilateral intermittent claudication lasting over a month.
  • She had asymptomatic AF with tachycardia, non-ischaemic dilated cardiomyopathy, and reduced ejection fraction (arrhythmia-induced cardiomyopathy).
  • The patient exhibited left atrial and left ventricular thrombi with multi-organ thromboembolism.

Findings:

  • The intermittent claudication was caused by multiple systemic thromboemboli originating from asymptomatic AF.
  • Beta-blockers for rate control were ineffective.
  • Amiodarone therapy, following anticoagulation, successfully restored sinus rhythm and improved ejection fraction.

Implications:

  • This case highlights that arrhythmia-induced cardiomyopathy (AiCM) in AF can lead to left ventricular thrombosis.
  • Systemic embolism from AF can manifest as prolonged intermittent claudication.
  • Effective management involves anticoagulation and rhythm control, potentially with amiodarone, to restore cardiac function.

Keywords:
ArrhythmiasHeart failureThrombosis

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