Massive Right Heart Thrombus Causing Complete Cardiac Obstruction Relieved by Thrombolysis: A Case Report
  • Christopher Wong
    Department of Cardiology, Concord Hospital, University of Sydney, Australia
  • John Yiannikas
    Department of Cardiology, Concord Hospital, University of Sydney, Australia

Keywords

Case report, right heart thrombus, thrombolysis, heart failure

Abstract

Background: Right heart thrombus (RHT) is a medical condition associated with acute pulmonary embolism and congestive cardiac failure. Rapid recognition is essential for instituting early treatment and preventing adverse outcomes.
Case summary: A 55-year-old male presented with symptoms of congestive cardiac failure complicated by cardiac arrest. Initial transthoracic echocardiography (TTE) demonstrated moderate impairment of both ventricles and a moderately dilated right ventricle (RV). After initial improvement with heart failure treatment, the patient subsequently had a second cardiac arrest. Bedside TTE revealed complete RV obstruction by thrombus, and intravenous thrombolysis was immediately instituted, with complete dissolution of the thrombus and haemodynamic recovery 15 minutes after treatment. Unfortunately, the patient suffered significant hypoxic brain injury and did not survive.
Discussion: RHT can manifest acutely in a dramatic fashion with cardiac arrest. Bedside TTE is key to making a rapid diagnosis in this setting to allow early administration of thrombolytic therapy.

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References

  • Cameron J, Pohlner PG, Stafford EG, O'Brien MF, Bett JH, Murphy AL. Right heart thrombus: recognition, diagnosis and management. J Am Coll Cardiol 1985;5:1239–1243.

  • Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3145–3146.

  • The European Working Group on Echocardiography. The European Cooperative Study on the clinical significance of right heart thrombi. Eur Heart J 1989;10:1046–1059.

  • Jafri SM, Ozawa T, Mammen E, Levine TB, Johnson C, Goldstein S. Platelet function, thrombin and fibrinolytic activity in patients with heart failure. Eur Heart J 1993;14:205–212.

  • Beemath A, Stein PD, Skaf E, Al Sibae MR, Alesh I. Risk of venous thromboembolism in patients hospitalized with heart failure. Am J Cardiol 2006;98:793–795.

  • Torbicki A, Galie N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ, et al. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003;41:2245–2251.

  • Kinney EL, Wright RJ. Efficacy of treatment of patients with echocardiographically detected right-sided heart thrombi: a meta-analysis. Am Heart J 1989;118:569–573.

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    Published: 2020-05-13
    Issue: 2020: Vol 7 No 8 (view)

    How to cite:
    1.
    Wong C, Yiannikas J. Massive Right Heart Thrombus Causing Complete Cardiac Obstruction Relieved by Thrombolysis: A Case Report. EJCRIM 2020;7 doi:10.12890/2020_001644.