以前,止血系统异常与充血性心力衰竭(CHF)有关。这里,我们报道了一例罕见的非缺血性心肌病伴右心房和双心室血栓的弥散性血管内凝血病(DIC)病例.我们介绍了一名55岁的女性,既往有支气管哮喘病史,有六天的双侧腿部肿胀和干咳病史。她入院时的体检对双心室心力衰竭的体征具有重要意义。初始检查对升高的脑钠肽前体(ProBNP)有意义,转氨酶升高,明显的血小板减少症(19,000/mcL),和凝血病,国际标准化比率(INR)为2.5,D-二聚体为15,585ng/mL。经胸超声心动图(TTE)显示,一个大的可移动的右心房血栓突出到右心室中,并且左心室(LV)血栓更加粘附,双心室收缩力严重降低。完成了PanCT检查,对于多灶性多叶肺栓塞具有重要意义。进行了下肢静脉双工,发现广泛的双侧下肢深静脉血栓形成(DVT)。此罕见病例显示DIC与非缺血性心肌病之间的异常关联,双心室血栓,广泛的深静脉血栓形成,和肺栓塞(PE)。相比之下,先前有多例DIC伴CHF和LV血栓的报告.然而,我们的病例在右心房和双心室血栓的存在方面与以前的报告不同.病人接受了抗生素治疗,利尿剂,并在持续低纤维蛋白原水平的情况下进行冷沉淀。患者接受了介入放射学引导的血栓切除术,以治疗广泛的肺栓塞,然后插入下腔静脉(IVC)过滤器。导致右心房血栓的消退和肺栓塞负担的广泛减少。然后,在血小板计数和纤维蛋白原水平恢复正常后,给予患者阿哌沙班。高凝状态检查尚无定论。患者在症状改善后出院。早期识别新发心力衰竭患者的DIC和心脏血栓对于实施正确的血栓切除术管理至关重要。优化心力衰竭药物,和抗凝以达到更好的结果。
Hemostatic system abnormalities have been previously associated with congestive heart failure (CHF). Here, we report a rare case of disseminated intravascular coagulopathy (DIC) in the setting of non-ischemic cardiomyopathy with right atrial and biventricular thrombus. We present a 55-year-old female with a past medical history of bronchial asthma who presented with a six-day history of bilateral leg swelling and dry cough. Her physical examination on admission was significant for signs of biventricular heart failure. Initial workup was significant for elevated pro-brain natriuretic peptide (ProBNP), elevated transaminases, marked thrombocytopenia (19,000/mcL), and coagulopathy with international normalized ratio (INR) of 2.5 and D-dimer of 15,585 ng/mL. Transthoracic echocardiogram (TTE) showed a large mobile right atrial thrombus protruding into the right ventricle and a more adherent left ventricular (LV) thrombus with severely reduced biventricular contractility. Pan CT was done and was significant for multifocal multilobar pulmonary emboli. A lower limb venous duplex was done and revealed extensive bilateral lower limb deep venous thrombosis (DVT). This rare case demonstrates an unusual association between DIC with non-ischemic cardiomyopathy, biventricular thrombus, extensive deep vein thrombosis, and pulmonary embolism (PE). In comparison, there are multiple prior reports for DIC with CHF and LV thrombus. However, our case differs from prior reports in terms of the presence of right atrial and biventricular thrombus. The patient received antibiotics, diuretics, and cryoprecipitate in the setting of persistent low fibrinogen levels. The patient underwent Interventional radiology-guided thrombectomy for extensive pulmonary emboli followed by inferior vena cava (IVC) filter insertion, resulting in the resolution of the right atrial thrombus and extensive decrease of the pulmonary emboli burden. The patient was then given apixaban after normalization of the platelet count and fibrinogen level. Hypercoagulability workup was inconclusive. The patient was then discharged after improvement of symptoms. Early recognition of DIC and cardiac thrombi in patients with new-onset heart failure is crucial for the implementation of the correct management by thrombectomy, optimizing heart failure medications, and anticoagulation to achieve better outcomes.