Intracavitary thrombosis LV and RV formation in a young patient with heart failure with reduced ejection fraction, clinical case

Abstract

Introduction. Intracardiac thrombi are a complication associated with cardiomyopathies. Studies indicate that intraventricular thrombi are a significant complication of heart failure with reduced ejection fraction and can range from 2.1% to 7.0% in patients with severe systolic dysfunction. Objective(s). Presentation of the clinical case of a young patient who developed dilated cardiomyopathy of post-inflammatory etiology with heart failure and reduced ejection fraction. Materials and methods. Patient B., 39 years old, admitted to the Cardiology Department of MSPI "Holy Trinity" with the following complaints: marked asthenia, dyspnea on light physical exertion, cardiac palpitations, retrosternal pain. From the anamnesis, the patient does not suffer from heart disease, a month ago he underwent ARVI with outpatient treatment. Investigations performed: electrocardiogram, echocardiography, chest radiography, hemoleukogram, biochemical analyses. Results. On admission: t 36.7°C, FCC 135 b/min, BP 100/60 mmHg, SpO2 - 98%, FR - 21/min. ECG: Sinusal rhythm with FCC 125 b/min, without signs of acute ischemia. Laboratory results: general analysis, biochemical blood test, coagulogram without changes, negative cardiac markers, elevated NTproBNP. Chest radiography: hydrothorax on the left. Ultrasound of internal organs: bilateral hydrothorax, ascites. EchoCG: tetracameral dilation, diffuse reduced EF 20%, PSAP 51 mmHg, restrictive diastolic dysfunction, apical thrombi in the LV and RV cavities partially fixed with elements. After 14 days, the general condition improved. On radiography, bilateral pleural resorption. ECHO: complete resorption of thrombi in the LV and RV, EF 26%, decreased NTproBNP (1034 to 844 pg/ml). Conclusion(s). Reduced ejection fraction is an established risk factor for the development of intracavitary thrombi in 20-25% of patients, which makes anticoagulant therapy even more crucial in preventing thromboembolic complications.