Wake Ryotaro, Muro Takashi, Hozumi Takeshi, Matsumoto Ryo, Kataoka Toru, Nakamura Yasuhiro, Takemoto Yasuhiko, Takagi Masahiko, Suehiro Shigefumi, Yoshiyama Minoru
Department of Internal Medicine and Cardiology in Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585, Japan.
Am J Emerg Med. 2008 Nov;26(9):1066.e5-7. doi: 10.1016/j.ajem.2008.03.018.
A 49-year-old Japanese man presented with orthopnea and edema in both legs. He was diagnosed with congestive heart failure with triple-vessel coronary artery disease. Low antithrombin and left ventricular systolic dysfunction were possible causes of his hypercoagulable state. Echocardiography revealed thrombi in the left ventricle and left trium, poor left ventricular contractility, and a normal mitral valve. Electrocardiogram revealed normal sinus rhythm. We found small infarctions of the brain and spleen in the computed tomography. The heparin treatment of cardiac thrombi is useless because the patient had heparin-induced thrombocytopenia antibody. We removed thrombi in the left ventricle and left atrium by thrombectomy and performed coronary artery bypass graft. Warfarin was administered for anticoagulation. He recovered completely and is now doing well. Our experience indicates that poor cardiac function can together cause multiple cardiac thrombi and subsequent thromboembolism without mitral stenosis or atrial fibrillation.
一名49岁的日本男性出现端坐呼吸和双下肢水肿。他被诊断为充血性心力衰竭合并三支冠状动脉疾病。抗凝血酶水平低和左心室收缩功能障碍可能是其高凝状态的原因。超声心动图显示左心室和左心房有血栓，左心室收缩性差，二尖瓣正常。心电图显示窦性心律正常。在计算机断层扫描中，我们发现脑部和脾脏有小梗死灶。由于患者有肝素诱导的血小板减少抗体，肝素治疗心脏血栓无效。我们通过血栓切除术清除了左心室和左心房的血栓，并进行了冠状动脉搭桥术。给予华法林进行抗凝治疗。他已完全康复，目前情况良好。我们的经验表明，心脏功能不佳可共同导致多发性心脏血栓形成及随后的血栓栓塞，而无二尖瓣狭窄或心房颤动。
