Severe hypercoagulable state on veno-arterial extracorporeal membrane oxygenation
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KeywordsPulmonary Edema Pericardial Effusion Plaque Rupture Hemodynamic Deterioration Hemodynamic Support
A previously healthy 49-year-old female presented to the emergency department with chest pain and was diagnosed with antero-lateral ST-segment elevation myocardial infarction. Urgent coronary angiography demonstrated the presence of transient coronary thrombi in the left anterior descending and circumflex arteries with no obvious plaque rupture. Severe biventricular dysfunction was also noted.
During the angiogram, she became extremely hemodynamically unstable. She was intubated and the decision was made to initiate hemodynamic support with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO). Concurrently, acute thrombi had formed in both iliac arteries during the procedure. Initial echocardiography showed a moderate pericardial effusion without signs of tamponade, a virtually non-contracting heart and a closed aortic valve.
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Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.