Pradhan Ravi R, Jha Ashish, Nepal Gaurav, Sharma Manju
Internal Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL.
Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL.
Cureus. 2018 Jul 11;10(7):e2964. doi: 10.7759/cureus.2964.
Valvular heart disease is one of the more common diseases in low- and middle-income countries, when associated with atrial fibrillation (AF), carries a risk of multisystemic embolizations. We report a case of 37-year-old man with multiple systemic emboli consisting of acute ischemic stroke, acute myocardial infarction, and acute limb ischemia. This is a rare occurrence in a single subject. The patient had a background of rheumatic heart disease (RHD) involving severe mitral stenosis (MS) with AF, who was not compliant with his medications. A computed tomography (CT) scan of the head showed right-sided ischemic stroke involving more than one-third of the middle cerebral artery territory. An electrocardiogram (ECG) showed AF and ST-segment elevation in V4 to V6. Cardiac enzymes were elevated. A transthoracic echocardiogram demonstrated hypokinetic left ventricular anterolateral wall, severe MS, and a left atrial clot. An arterial Doppler of the right lower limb showed an occluding thrombus of the right common femoral artery and right popliteal artery with no flow in color Doppler. Patient adherence to medications in cases of RHD prevents devastating outcomes.
心脏瓣膜病是低收入和中等收入国家较常见的疾病之一，当与心房颤动（AF）相关时，会有发生多系统栓塞的风险。我们报告一例37岁男性患者，出现多处全身性栓塞，包括急性缺血性中风、急性心肌梗死和急性肢体缺血。这种情况在单个个体中较为罕见。该患者有风湿性心脏病（RHD）病史，伴有严重二尖瓣狭窄（MS）及房颤，且未遵医嘱服药。头部计算机断层扫描（CT）显示右侧缺血性中风，累及大脑中动脉区域超过三分之一。心电图（ECG）显示房颤及V4至V6导联ST段抬高。心肌酶升高。经胸超声心动图显示左心室前外侧壁运动减弱、严重二尖瓣狭窄及左心房血栓。右下肢动脉多普勒检查显示右股总动脉和右腘动脉有阻塞性血栓，彩色多普勒显示无血流信号。风湿性心脏病患者坚持服药可预防严重后果。
