Floating disaster : a case of a mobile left atrial thrombus in a patient with atrial fibrillation secondary to rheumatic heart disease

Publication Date

2000

Document Type

Research

Abstract

A 75 year old female, presented with upper gastrointestinal bleeding and subsequent myocardial infarction. The patient's 2D echocardiogram revealed the findings of Rheumatic Heart Disease; Mitral Stenosis, moderate to severe (MVA = 1.0 cm2); Mitral Regurgitation, severe; Tricuspid Regurgitation, severe. Moderate to severe pulmonary hypertension (Pulmonary Artery Systolic Pressure = 66mmHg). Concentric LVH with segmental wall motion abnormality with mildly depressed LV Systolic function (EF=56%). Dilated LA with mobile thrombus (2.4x2.1cm). On the 2nd hospital day, cleared by gastroenterology service to start Fondaparinux 2.5mg subcutaneous injection once a day and Warfarin 5mg ½ tablet once a day. Patient was advised to undergo open heart surgery but opted medical management.

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