A Young Male Patient With Multiple Thromboembolisms Associated With Factor V Leiden Mutation

Abstract

SummaryFactor V Leiden (FVL) mutation is the most common hereditary thrombophilia. Association of this mutation with venous thrombosis is well established. However, there are several conflicting results regarding the association of FVL with arterial thrombosis, acute coronary syndrome, and intracardiac thrombosis. In this case report, we present a 44-yearold male patient with a medical history of both arterial and venous thrombosis who came to our emergency department with chest pain. After the initial evaluation he was diagnosed as having acute coronary syndrome and transthoracic echocardiography revealed an intracardiac apical thrombus. Coronary angiography showed non-critical stenosis. Thrombophilia panel was studied and the patient was found to be heterozygotic for FVL mutation. An apical thrombus was extracted surgically because of the high risk of systemic embolization. (Int Heart J 2016; 57: 654-656) Key words: Acute coronary syndrome, Intracardiac thrombus, Normal coronary arteries, Apical thrombus F VL mutation is the most common hereditary thrombophilia with a prevalence of heterozygous carriers of 3-5%. 1) Association of this mutation with venous thromboembolism is well established. However, there are conflicting data on the association between FVL with arterial thrombosis and acute coronary syndrome. Intracardiac thrombosis (ICT) is a rare clinical condition, except those associated with cardiomyopathies, atrial fibrillation, and post-infarction period.2) Rare causes of ICT are hereditary thrombophilias and other hypercoagulable states. Case ReportA 44 year-old male patient presented to the emergency department with worsening chest pain of 3 hours duration. His medical history revealed deep venous thrombosis in the left popliteal vein 4 years previously. He was on warfarin therapy then and 6 months later the therapy was stopped by his physician. Three months later he visited our emergency department complaining of sudden onset leg pain. Arterial Doppler ultrasonography revealed acute thrombus in the left popliteal artery and the patient underwent below knee peripheral by-pass surgery. After the surgery the patient was prescribed warfarin which he did not use. Physical examination revealed nothing important. His arterial blood pressure was 130/80 mmHg, Oxygen saturation was 98% at room air. His ECG showed 2 mm ST segment depression in leads V1 to V4. Routine blood tests were normal except elevated high sensitive cardiac troponin (342 ng/L, normal range: 0-34 ng/L) and CK-MB (48 µg/L, normal range: < 8.7 µg/L) levels. On transthoracic echocardiography, the left ventricular diastolic and systolic diameters were 5.7 and 4.3 cm, respectively, the ejection fraction calculated with the Simpson method was 43%, and the anterior and anteroseptum segments were hypokinetic. Apical 4-chamber view revealed an apical mobile thrombus (4.1 × 2.1 cm) (Figure 1). Right ventricular function and size were normal. Contrasted computed thorax tomography confirmed a thrombus in the left ventricle (Figure 2). Afterwards, h...

Thrombosis risk factors and gene mutations in young age patients with acute coronary syndrome

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A Case of Left Ventricular Thrombus with Superior Mesenteric Vein Thrombosis Due to Atopic Dermatitis

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Thrombophilia with an onset symptom of intracranial venous thrombosis: A case report and review of the literature

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