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.