Mystakidi Vasiliki Chara, Oikonomou Evangelos, Katsianos Efstratios, Vavuranakis Manolis
3rd Department of Cardiology, Athens Chest Hospital "Sotiria", National and Kapodistrian University of Athens, Medical School, 152 Mesogeion Avenue, Athens 11527, Greece.
Eur Heart J Case Rep. 2022 Feb 14;6(2):ytac076. doi: 10.1093/ehjcr/ytac076. eCollection 2022 Feb.
Intracardiac thrombi are a complication associated with cardiomyopathies. In heart failure with reduced ejection fraction, there is a hypercoagulable state that can increase the incidence of left ventricular thrombus and result in higher risk of thromboembolism, either manifested as stroke or as peripheral thromboembolic event. Haemoconcentration following decongestion treatment may enhance blood viscosity.
A 63-year-old man with known long-standing heart failure (HF) of ischaemic aetiology and not any prothrombotic risk, admitted with congestive HF and treated with aggressive decongestion treatment with intravenous loop diuretics. During his hospital stay, and following decongestion and haemoconcentration, a left ventricular (LV) intracardiac thrombus formation was detected by echocardiography, which occurred in the absence of a recent myocardial infarction or adverse LV remodelling. The patient was treated with oral anticoagulation therapy. There was a complete resolution of the thrombus on repeat transthoracic echocardiography after 4 weeks of treatment.
Aggressive decongestive treatment, haemoconcentration and increased blood viscosity following HF decompensation may serve as a trigger for intracardiac thrombus formation under the appropriate prothrombotic background. Appropriate primary antithrombotic prophylaxis is an issue raised concerns and vulnerable patients need closed clinical and imaging follow-up.
心内血栓是心肌病相关的一种并发症。在射血分数降低的心力衰竭中，存在高凝状态，可增加左心室血栓的发生率，并导致更高的血栓栓塞风险，表现为中风或外周血栓栓塞事件。充血治疗后的血液浓缩可能会提高血液粘度。
一名63岁男性，已知患有缺血性病因的长期心力衰竭（HF），无任何血栓形成前风险，因充血性HF入院，接受静脉袢利尿剂积极充血治疗。在住院期间，充血和血液浓缩后，经超声心动图检测发现左心室（LV）心内血栓形成，这发生在近期无心肌梗死或不良左心室重构的情况下。该患者接受了口服抗凝治疗。治疗4周后经胸超声心动图复查显示血栓完全溶解。
在适当的血栓形成前背景下，积极的充血治疗、HF失代偿后的血液浓缩和血液粘度增加可能是心内血栓形成的触发因素。适当的一级抗血栓预防是一个引起关注的问题，脆弱患者需要密切的临床和影像学随访。
