Kanjirakadavath Babu, Krishnan M N, Vinayakumar D, Raju Deepak, Nithin P G, Rajesh K F, Sreekumar Pradeep
Department of Cardiology, Government Medical College, Kozhikode, India.
Indian Heart J. 2013 Jul-Aug;65(4):457-9. doi: 10.1016/j.ihj.2013.06.008. Epub 2013 Jul 10.
We report a 42-year-old lady on combined oral contraceptive pills with deep venous thrombosis and mild pulmonary embolism, who developed shock, while being treated with heparin. On auscultation, there was an unexpected loud, superficial, squeaky, triphasic friction rub over the left lower parasternal area. Simultaneous echocardiogram revealed a large serpiginous, freely floating mass in right atrium, prolapsing freely to right ventricular inlet across the tricuspid valve. The endocardial friction rub persisted for about 24 h as long as the thrombus was intracardiac and disappeared when the thrombus disappeared from right heart, occluding the proximal left pulmonary artery. She died due to shock awaiting surgery. We highlight that such a rub in a patient with deep venous thrombosis, though rare, may be an important clue to impending pulmonary embolism.
我们报告了一位42岁服用复方口服避孕药的女性，她患有深静脉血栓形成和轻度肺栓塞，在接受肝素治疗时出现休克。听诊时，在左下胸骨旁区域意外发现响亮、表浅、嘎吱作响的三相摩擦音。同时，超声心动图显示右心房有一个大的匐行性、自由漂浮的肿块，经三尖瓣自由脱垂至右心室入口。只要血栓位于心腔内，心内膜摩擦音就持续约24小时，当血栓从右心消失并阻塞左肺动脉近端时，摩擦音消失。她因等待手术时休克死亡。我们强调，深静脉血栓形成患者出现这种摩擦音虽然罕见，但可能是即将发生肺栓塞的重要线索。
