Sharma Harish, George Sudhakar
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.
Case Rep Cardiol. 2020 Jul 18;2020:8882463. doi: 10.1155/2020/8882463. eCollection 2020.
Left ventricular thrombus (LVT) is a complication of acute myocardial infarction (AMI) due to localised haemostasis. LVT is typically seen 3-12 days following AMI and is seldom seen within the first 24 hours. LVT increases the risk of mortality due to systemic thromboembolism. Patients with Coronavirus Disease-19 (COVID-19) are potentially hypercoagulable and this may promote early development of LVT.
A 50-year-old man with no past medical history was admitted with a severe diabetic ketoacidosis following a 4-day history of cough and fever. The patient tested positive for COVID-19 and required intensive care treatment for ventilation and haemofiltration. After returning to ward-based care, the patient developed chest pain and electrocadiographic changes consistent with an acute anterior ST-elevation myocardial infarction. Emergency percutaneous coronary intervention was performed to the left anterior descending artery. However, the patient developed diuretic-resistant pulmonary oedema and a bedside echocardiogram revealed significant LVT despite only 4 hours of chest pain. The thrombus was associated with the anteroseptal wall of the left ventricle which was hypokinetic but not aneurysmal. An intra-aortic balloon pump (IABP) was inserted, but the patient developed ipsilateral lower limb ischaemia due to the formation of thrombus in the femoral artery and irreversible cardiogenic shock from which he ultimately succumbed.
COVID-19-positive patients are potentially hypercoagulable, and MI in this population may precipitate LVT earlier than expected. Consideration should be made for routine early screening of post-MI COVID-19 patients for LVT. If detected, anticoagulation may reduce the risk of cardiovascular mortality in this high-risk group.
左心室血栓（LVT）是急性心肌梗死（AMI）局部止血导致的并发症。LVT通常在AMI后3 - 12天出现，很少在最初24小时内见到。LVT会增加因系统性血栓栓塞导致的死亡风险。2019冠状病毒病（COVID - 19）患者可能存在高凝状态，这可能促使LVT早期形成。
一名50岁男性，既往无病史，因咳嗽发热4天后出现严重糖尿病酮症酸中毒入院。该患者COVID - 19检测呈阳性，需要重症监护进行通气和血液滤过治疗。回到病房护理后，患者出现胸痛及心电图改变，符合急性前壁ST段抬高型心肌梗死。对左前降支进行了急诊经皮冠状动脉介入治疗。然而，患者出现利尿剂抵抗性肺水肿，床边超声心动图显示尽管仅胸痛4小时，但已有明显的LVT。血栓与左心室前间隔壁相关，该部位运动减弱但未形成室壁瘤。插入了主动脉内球囊泵（IABP），但患者因股动脉血栓形成出现同侧下肢缺血，并最终死于不可逆的心源性休克。
COVID - 19阳性患者可能存在高凝状态，该人群中的心肌梗死可能比预期更早地促使LVT形成。应考虑对AMI后的COVID - 19患者进行常规早期LVT筛查。如果检测到LVT，抗凝治疗可能会降低这一高危人群的心血管死亡风险。
