Successful treatment of mobile right atrial thrombus and acute pulmonary embolism with intravenous tissue plasminogen activator
Department of Internal Medicine, Division of Cardiology
Acute Disease; Aged, 80 and over; Female; Fibrinolytic Agents; Heart Atria; Humans; Infusions, Intravenous; Pulmonary Embolism; Thrombosis; Tissue Plasminogen Activator
Cardiology | Cardiovascular Diseases
An 89-year-old woman came with symptoms of progressively worsening dyspnoea at rest over the preceding week. She was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed atrial fibrillation with the rapid ventricular rate. Labs were significant for markedly elevated pro-brain natriuretic peptide of 43,000 pg/mL and troponin-T of 1 ng/mL. An urgent 2D echocardiogram was obtained, which revealed the severely dilated right atrium and a large linear mobile mass in the right atrium consistent with a thrombus. An emergent CT scan revealed multiple bilateral pulmonary emboli. She received intravenous tissue plasminogen activator. Repeat echocardiogram performed 6 h later showed no evidence of the right atrial thrombus. She was subsequently maintained on intravenous heparin and transitioned to Coumadin. Early recognition of this rare but potentially fatal complication is important as prompt treatment measures can help in preventing life-threatening complications of the right atrial thrombus.
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Citation: BMJ Case Rep. 2013 Jul 25;2013. pii: bcr2013010255. doi: 10.1136/bcr-2013-010255. Link to article on publisher's site
BMJ case reports
Bajaj, Rishi; Ramanakumar, Ajay; Mamidala, Suresh; and Kumar, Deepti, "Successful treatment of mobile right atrial thrombus and acute pulmonary embolism with intravenous tissue plasminogen activator" (2013). University of Massachusetts Medical School Faculty Publications. 473.