Left ventricular mural thrombus and dual coronary embolization associated with hyperthyroid cardiomyopathy and atrial fibrillation: a case report

Abstract

BackgroundThe majority of acute myocardial infarction (AMI) events are caused by thrombotic occlusion of the coronary artery, secondary to atherosclerotic plaque erosion or rupture. However, coronary embolism (CE), while rare, is being increasingly recognized as an important cause of AMI. We present the case of a patient with multi-site coronary artery embolization associated with hyperthyroid-related cardiomyopathy and atrial fibrillation.Case presentationA 49-year-old female with a history of hyperthyroidism and atrial fibrillation (AF) was admitted to our hospital presenting with right upper limb pain and swelling. Initial transthoracic echocardiography demonstrated left ventricular apical mural thrombi and hyperthyroidism-induced cardiomyopathy. On the eighth day after admission, the patient developed sudden onset of severe chest pain and evidence of acute myocardial infarction (AMI). Emergency coronary angiography revealed multi-site coronary embolization of the left anterior descending artery and a large diagonal branch. Despite emergency thrombo-aspiration and balloon angioplasty, the patient went into ventricular fibrillation, from which she did not recover.ConclusionAlthough rare, a fatal case of left ventricular thrombus and dual-vessel coronary embolism associated with hyperthyroid cardiomyopathy and atrial fibrillation is reported.

Acute Myocardial Infarction From Embolized Left Ventricular Thrombus in Coronavirus Disease 2019

“…A coronary embolic phenomenon is quite rare but is being increasingly recognized as an etiology of acute MI. 4 Nevertheless, a fully asymptomatic development of LV thrombus and subsequent embolization down the coronary arteries resulting in a STEMI caught on telemetry was a novel exposure for all involved in the care of this patient and posed unique challenges in his management. Unlike this case, other case reports of LV thrombus with STEMI in COVID-19 have evidence of LV dysfunction, hemodynamic and electrophysiologic compromise, and are symptomatic on presentation.…”

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“…Thyroid hormones could influence the structure of LV due to longterm hyperthyroidism, leading to concentric cardiac hypertrophy (6,7). If left untreated for a long time, this could lead to heart failure (8,9).…”