Intra-Cardiac Thrombus in COVID-19 pandemic – Case Series and Review

Abstract

Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. n addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.

Left ventricular thrombus with normal systolic function secondary to the novel prothrombotic association of acute on chronic calcific pancreatitis and COVID-19

“…In most cases, the associated procoagulant state is responsible for the development of LVT. The presence of COVID-19 increases the risk of thrombus formation [1] .…”

“…Common causes of left ventricular thrombus (LVT) formation include scarred culprit-vessel territories secondary to nonreperfused myocardial infarction (MI), non-ischemic cardiomyopathy, non-compaction of LV, endomyocardial fibrosis, and longstanding arrhythmias. However, in the context of large MIs associated with apical akinesia or dyskinesia, LV aneurysms are frequently predisposed to forming LVT [1] . The hypercoagulable or inflammatory disorder can rarely predispose to the formation of LVT [2] .…”

“…The hypercoagulable or inflammatory disorder can rarely predispose to the formation of LVT [2] . Infection with coronavirus disease 2019 (COVID-19) is associated with a remarkably hypercoagulable state that increases the risk of the early development of LVT in the setting of MI or underlying prethrombotic conditions [1] .…”

Multiple biventricular thrombi in a patient with alcoholic cardiomyopathy and COVID-19: A tragic association in a deadly pandemic

“…Predisposing factors for the development of multiple intracardiac thrombi in our case, according to the Virchow triad, are 1) impaired ventricular wall motion - secondary to severe LV dysfunction, 2) local myocardial injury – alcohol functions as a toxin when consumed in large quantities for a prolonged period, 3) hypercoagulability/flow stasis – a prothrombotic state brought about by COVID-19 infection. Hypercoagulability and LV thrombi formation in COVID-19 has been demonstrated in a recently published case series [ 3 ]. In the literature, there are limited case reports of multiple LV thrombus or BVT in COVID-19 patients.…”

“…It induces left ventricular (LV) dilation and dysfunction, which leads to heart failure with a reduced ejection fraction (HFrEF) [ 2 ]. Coronavirus disease −19 (COVID-19) infection is a prothrombotic state that predisposes the formation of thrombosis in different vascular territories, including the intracardiac chambers [ 3 ]. We present a case in which multiple BVT developed as a result of the COVID-19 infection in patients with underlying ACMP.…”