Free floating right atrial thrombus with massive pulmonary embolism:near catastrophic course following thrombolytic therapy

Autor: Ravindranath Khandenahally Shankarappa, Ravi S. Math, Srinivas Papaiah, Yeriswamy M. Channabasappa, Satish Karur, Manjunath Cholenahally Nanjappa
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Indian Heart Journal, Vol 65, Iss 4, Pp 460-463 (2013)
Druh dokumentu: article
ISSN: 0019-4832
DOI: 10.1016/j.ihj.2013.06.015
Popis: A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.
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