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Multiple cardioembolic attacks with a huge ventricular thrombus in dilated cardiomyopathy: A case report and
Maziar Moayerifar1, Mani Moayerifar2,3, Mahboobeh Gholipour4
1Department of Vascular Surgery, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Insights
This case report highlights how methamphetamine abuse and gout can contribute to left ventricular thrombus in dilated cardiomyopathy. Prompt anticoagulant therapy successfully resolved the thrombus and improved patient symptoms.
Area of Science:
- Cardiology
- Toxicology
- Rheumatology
Background:
- Left ventricular thrombus (LVT) is a serious complication of dilated cardiomyopathy (DCM).
- Risk factors for LVT include DCM, but other conditions like gout and substance abuse are less understood.
- Embolization from LVT can lead to severe ischemic events.
Purpose of the Study:
- To report a case of LVT in a patient with DCM, methamphetamine abuse, and gout.
- To investigate the potential contributing factors to LVT formation in this complex case.
- To illustrate the management and outcome of LVT in a patient with multiple comorbidities.
Main Methods:
- Case report presentation of a male in his early 40s.
- Echocardiography to diagnose left ventricular thrombus.
- Treatment with heparin, warfarin, and probenecid.
Main Results:
- The patient presented with multiple ischemic attacks, including acute limb ischemia, dysarthria, and renal infarct.
- Echocardiography confirmed a large left ventricular thrombus.
- Anticoagulant therapy led to thrombus resolution and symptom improvement.
Conclusions:
- Methamphetamine abuse and elevated uric acid levels (gout) may contribute to LVT in DCM.
- Early anticoagulation is crucial for managing LVT and preventing cardioembolic events.
- Further research is needed to fully understand the interplay of these factors in cardiac thrombosis.
Abstract:
Left ventricular thrombus is one of the major complications of dilated cardiomyopathy. Although the presence of a cardiac thrombus is a major risk factor for embolization, several probable conditions, the connection of which is not thoroughly studied, such as gout disease and methamphetamine abuse, are also possible causes. We present the case report of a male in his early 40s with a history of alcohol and methamphetamine abuse, gout, and dilated cardiomyopathy, experiencing multiple ischemic attacks, including acute limb ischemia, dysarthria, and renal infarct. Echocardiography revealed a large clot in the left ventricle. The patient received heparin at a rate of 1000 units/hour, followed by warfarin at 10 mg/day, and probenecid at 500 mg/day. The thrombus resolved upon anticoagulant therapy, with improvement in the patient's symptoms. Left ventricular thrombus formation in dilated cardiomyopathy is influenced by many factors, including drug toxicity (for instance, methamphetamine), uric acid levels, and N-terminal precursor B-type natriuretic peptide. The thrombus can cause cardioembolic attacks in multiple sites, and the choice for emergent therapy is an oral anticoagulant, which may improve the ejection fraction. However, certain aspects related to cardiac thrombosis and embolization risk still warrant more comprehensive studies.
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