The case of the disappearing left ventricular apical thrombus
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KeywordsCardiomyopathy Atrial Flutter Extremity Pain Left Ventricular Apex Left Ventricular Thrombus
A 60-year-old male presented to the cardiologist for symptoms of palpitations. Over three months, he reported an increase in palpitations with a heart rate ranging in the 140s. He had an incident of acute right foot pain with a subsequent residual cool right foot and toe with numbness.
In follow-up, the patient was found to be in atrial flutter with a rate of 136. An echocardiogram showed severe left ventricular (LV) systolic dysfunction and a non-mobile round echodensity in the apex measuring 2.2cm, consistent with an LV thrombus.
He was admitted to the hospital for anticoagulation, and a cardiac MRI was ordered.
Subsequently, the patient had multiple stable serial Cr levels (1.3-1.4) over the course of a month, and the patient remained asymptomatic on outpatient oral anticoagulation.
Presumably, the etiology of the patient’s thrombus was related to the atrial flutter with either a non-specific cardiomyopathy or tachycardia-induced cardiomyopathy. Various studies report detectable thrombi in 8-14% of patients with atrial fibrillation. Peripheral embolization reportedly occurs at a rate of 6.3 %. As demonstrated by the discussed case, it is possible that the actual embolic rate is higher.
This article is published under license to BioMed Central Ltd.