Case 11: Left Ventricle Clot
A 39-year-old female was admitted with chest pain, orthopnea, cough
seven days before admission. Moreover, she had a history of asthma.
Vital signs included temperature = 37.22, systolic blood pressure =
100/60 mmHg, heart rate = 125/min, and O2 saturation =
90% without an oxygen supply. Also, a chest x-ray showed GGO in both
lungs (Figure 1K). Echocardiographic revealed LVEF = 30-35%, normal LV
size, mild RV enlargement (restrictive diastolic pattern), moderate
tricuspid and mitral regurgitation, and mild pericardial effusion.
Coronary CT angiography also was normal. Cardiac magnetic resonance
(CMR) revealed myocardial edema and hyperemia in favor of active
myocarditis. Subepicardial and subendocardial fibrosis in the middle
part of the inferoseptal wall was also present. Dexamethasone (4 mg
every 8 hours) was administered three days. Subsequently, her vital
signs and oxygen saturation (98% in room air) improved. After
treatment, echocardiography revealed LVEF of 45% and hypermobile clot
in the left ventricular (1.5 × 1.5 centimeters) (Figure 6). Although
cardiothoracic surgery consultation suggested surgery removal of the
clot, the patient did not accept the surgery. So, the patient went under
anticoagulation therapy (heparin 24000 U/24 hours). After three days,
the clot had disappeared on the repeated echocardiography, and there
were no signs of embolism. The patient discharged in good condition on
β-blocker, angiotensin-converting enzyme (ACE) inhibitor,
spironolactone, and warfarin.