Haseeb Ul Rasool Muhammad, Persand Dhandevi, Salam Sanna
Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA.
Cureus. 2023 Feb 20;15(2):e35211. doi: 10.7759/cureus.35211. eCollection 2023 Feb.
Heart failure results in significant morbidity and mortality. Heart failure with reduced ejection fraction (HfrEF) in the absence of atrial fibrillation has been increasingly considered an independent risk factor for ischemic stroke, partly because of the development of left ventricular thrombus and subsequent cardioembolic stroke and partly because of hemodynamic impairment. Here, we present a case of a 60-year-old male with heart failure with reduced ejection fraction, who presented with cardioembolic ischemic stroke. In the investigation to localize the source, he was found to have slow intra-ventricular blood flow, which over shorter periods of follow up lead to the development of left ventricle intra-mural thrombi. Meanwhile, the patient also developed hemorrhagic conversion in the ischemic stroke, which further complicated the choice of anticoagulation. To date, no consensus has been developed on the choice of anticoagulation and clinical criteria for the use of anticoagulation in patients having HfrEF and sinus rhythm. This case brings forth a need for further research on whether anticoagulation would be beneficial in patients with HfrEF and sinus rhythm.
心力衰竭会导致显著的发病率和死亡率。在没有心房颤动的情况下，射血分数降低的心力衰竭（HfrEF）越来越被认为是缺血性中风的独立危险因素，部分原因是左心室血栓的形成及随后的心源性栓塞性中风，部分原因是血流动力学损害。在此，我们报告一例60岁男性射血分数降低的心力衰竭患者，其表现为心源性栓塞性缺血性中风。在寻找血栓来源的检查中，发现他的心室内血流缓慢，在较短的随访期间导致左心室壁内血栓形成。同时，该患者的缺血性中风还发生了出血性转化，这进一步使抗凝治疗的选择复杂化。迄今为止，对于HfrEF和窦性心律患者的抗凝治疗选择及使用抗凝治疗的临床标准尚未达成共识。该病例提出了一个问题，即对于HfrEF和窦性心律患者，抗凝治疗是否有益，这需要进一步研究。
