Related Experiment Video
Updated: Jun 21, 2025
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
The Management of Intracardiac Thrombus in a COVID-19 Patient Using IV Thrombolytics: A Case Report
Vandana Bandari1, Sai Rakshith Gaddameedi2, Shaji Faisal3
1Internal Medicine, Bayhealth Medical Center, Dover, USA.
Insights
This case report details a rare intracardiac thrombus in a COVID-19 patient. Prompt thrombolytic therapy led to complete resolution and symptom improvement.
Area of Science:
- Cardiology
- Infectious Diseases
- Hematology
Background:
- The COVID-19 pandemic is associated with increased thrombotic events, posing significant clinical challenges.
- While arterial and venous thromboembolism are common, intracardiac thrombus is a rare complication.
Observation:
- A 60-year-old male with COVID-19 presented with respiratory distress and was found to have an intracardiac thrombus in the right atrium and ventricle.
- Initial treatment with remdesivir was insufficient, and a nuclear medicine scan was inconclusive.
Findings:
- A 2D echocardiogram confirmed the presence of an intracardiac thrombus.
- Intravenous thrombolytic therapy with alteplase and heparin resulted in significant respiratory improvement and symptomatic relief.
- Follow-up echocardiogram showed complete thrombus resolution and normal cardiac function.
Implications:
- This case highlights the potential for severe thrombotic complications, including intracardiac thrombus, in COVID-19 patients.
- Early recognition and multidisciplinary management, including thrombolytic therapy, are crucial for favorable outcomes.
- The findings underscore the complex prothrombotic state induced by COVID-19 infection.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic has unveiled numerous clinical challenges, particularly its association with thrombotic events, which significantly contribute to morbidity and mortality. While thrombotic complications such as arterial and venous thromboembolism (VTE) are well-documented, instances of intracardiac thrombus are notably rare. This case report discusses a 60-year-old male with COVID-19 who came to the hospital due to respiratory distress. Despite treatment with remdesivir, the patient's condition worsened prompting further workup. His nuclear medicine (NM) ventilation-perfusion scan was inconclusive, but a 2D echocardiogram showed an intracardiac thrombus in the right atrium (RA) and right ventricle (RV). As the patient's condition worsened, necessitating a transition from nasal cannula to high-flow nasal cannula, a decision was made to treat him with intravenous (IV) thrombolytic therapy. The patient received 100 mg IV alteplase and IV heparin, resulting in significant respiratory improvement and symptomatic relief. A repeat echocardiogram after 48 hours showed normal ejection fraction and complete thrombus resolution. In conclusion, this case highlights the complex link between COVID-19 infection and prothrombotic states, leading to severe complications such as intracardiac thrombus in transit. The successful treatment of this patient through a multidisciplinary approach and thrombolytic therapy underscores the importance of prompt recognition and intervention in high-risk cases.
