SHM Converge Scientific Abstract ePoster Gallery-Left Ventricular Thrombus Formation With a Normal Ejection Fraction in a Covid-19 Patient

Pdf Summary

This case report describes a rare instance of left ventricular thrombus (LVT) developing in a patient with a normal ejection fraction during hospitalization for severe COVID-19 infection. LVT is usually associated with acute myocardial infarction and reduced EF, but it can also occur in hypercoagulable inflammatory states.<br /><br />A 56-year-old unvaccinated man with hypertension, diabetes, hyperlipidemia, obesity, sleep apnea, depression, and a remote smoking history presented with 5–6 days of dyspnea, cough, fever, dizziness with exertion, and diarrhea. Testing confirmed SARS-CoV-2 infection. Initial evaluation showed normal BNP, nonischemic EKG, normal troponin, and markedly elevated inflammatory and coagulation markers, including D-dimer, fibrinogen, CRP, ferritin, and LDH. Chest imaging showed bilateral COVID-19 pneumonia.<br /><br />He was treated with dexamethasone, remdesivir, and prophylactic LMWH. His respiratory status worsened, requiring non-invasive support and later intubation. He developed paroxysmal atrial fibrillation and was started on heparin. On hospital day 12, transthoracic echocardiography revealed an apical LVT measuring 1.8 x 1.1 cm despite normal EF and normal wall motion. HIT was considered but heparin PF4 antibody testing was negative. Later, he developed seizure-like activity, and brain MRI showed a subacute MCA infarct, suggesting embolic complication. He remained on heparin after weighing risks and benefits, but ultimately died from refractory shock and hypoxemia.<br /><br />The authors emphasize that COVID-19 can create a hypercoagulable and endothelial-injury state consistent with Virchow’s triad, potentially leading to LVT even without ventricular dysfunction. Echocardiography is useful for detection, while cardiac MRI is the diagnostic gold standard.

Asset Subtitle

Michael Frerick

Meta Tag

Author List Aditya Kesari, Evan Parsley, Jay Anderson, Michael Frerick

Category Clinical Vignettes

Concept Left Ventricular Thrombus

Concept Acute Myocardial Infarction

Concept Hypercoagulable State

Concept COVID-19

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization OhioHealth

Presenting Author Michael Frerick

Track Adult

Keywords

left ventricular thrombus

COVID-19

hypercoagulable state

normal ejection fraction

embolic stroke

atrial fibrillation

echocardiography

endothelial injury

Virchow triad

case report

Left Ventricular Thrombus

Acute Myocardial Infarction

Hypercoagulable State

COVID-19

Echocardiography