Zhu Chao, Zhou Li, Gao Hongli, Wang Jiali, Li Jiayu, Chen Hui, Li Hongwei
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Dec 8;9:1019945. doi: 10.3389/fcvm.2022.1019945. eCollection 2022.
Left ventricular thrombus (LVT) is a well-recognized complication of myocardial infarction (MI) in patients with diabetes. An embolic complication caused by LVT is a key clinical problem and is associated with worsened long-term survival.
A 45-year-old man with persistent left abdominal pain for 1 week and left leg fatigue was admitted to the emergency department. The cause of abdominal pain was embolism of the renal artery, the splenic artery, and the superior mesenteric artery caused by cardiogenic thrombosis, which further led to splenic infarction and renal infarction. It was unclear when MI occurred because the patient had no typical critical chest pain, which may have been related to diabetic complications, such as diabetic peripheral neuropathy. Diabetes plays a pivotal role in MI and LVT formation. Because coronary angiography suggested triple vessel disease, percutaneous transluminal coronary angioplasty (PTCA) was conducted, and two drug-eluting stents were placed in the left anterior descending coronary artery (LAD). Due to a lack of randomized clinical control trials, the therapy of LVT and associated embolization has been actively debated. According to the present guidelines, this patient was treated with low-molecular-weight heparin and warfarin (oral anticoagulants) for 3 months in addition to aspirin (100 mg/day) and clopidogrel (75 mg/day) for 1 year. No serious bleeding complications were noted, and a follow-up examination showed no thrombus in the left ventricle or further peripheral thrombotic events.
Peripheral embolization of LVT caused by MI leading to multiple organ embolization remains a rare occurrence. Diabetes plays a pivotal role in MI and LVT formation. Successful revascularization of the infarct-related coronary artery and anticoagulation therapy is important to minimize myocardial damage and prevent LVT. The present case will help clinicians recognize and manage LVT in patients with diabetes and related peripheral arterial thrombotic events with anticoagulation.
左心室血栓（LVT）是糖尿病患者心肌梗死（MI）的一种公认并发症。LVT引起的栓塞并发症是一个关键的临床问题，与长期生存率恶化相关。
一名45岁男性因持续左腹痛1周和左腿乏力入住急诊科。腹痛原因是心源性血栓形成导致肾动脉、脾动脉和肠系膜上动脉栓塞，进而导致脾梗死和肾梗死。由于患者没有典型的严重胸痛，不清楚MI何时发生，这可能与糖尿病并发症如糖尿病周围神经病变有关。糖尿病在MI和LVT形成中起关键作用。因为冠状动脉造影显示三支血管病变，进行了经皮冠状动脉腔内血管成形术（PTCA），并在左前降支冠状动脉（LAD）置入了两枚药物洗脱支架。由于缺乏随机临床对照试验，LVT及相关栓塞的治疗一直存在激烈争论。根据现行指南，该患者除服用阿司匹林（100毫克/天）和氯吡格雷（75毫克/天）1年外，还接受了低分子量肝素和华法林（口服抗凝剂）治疗3个月。未观察到严重出血并发症，随访检查显示左心室无血栓或进一步的外周血栓形成事件。
MI导致LVT外周栓塞进而引起多器官栓塞仍然罕见。糖尿病在MI和LVT形成中起关键作用。梗死相关冠状动脉成功再血管化和抗凝治疗对于减少心肌损伤和预防LVT很重要。本病例将有助于临床医生认识和处理糖尿病患者的LVT以及相关外周动脉血栓形成事件并进行抗凝治疗。
