Antiaggregant and anticoagulant therapy of free-floating thrombus in left atrium/Sol atriyumda serbest dolasan trombusun antiagregan ve antikoagulan ajanlarla tedavisi.A 43-year-old female patient presented with dyspnea and palpitation palpitation (păl'pĭtā`shən), abnormal heartbeat that is often associated with a sensation of fluttering or thumping. The normal heartbeat is not noticeable to the individual. . Electrocardiogram electrocardiogram /elec·tro·car·dio·gram/ (-kahr´de-o-gram?) a graphic tracing of the variations in electrical potential caused by the excitation of the heart muscle and detected at the body surface. showed atrial fibrillation. Echocardiography Echocardiography Definition Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart's valves and showed a large left atrial thrombus thrombus /throm·bus/ (throm´bus) pl. throm´bi a stationary blood clot along the wall of a blood vessel, frequently causing vascular obstruction. with moving to left ventricle. A transesophageal echocardiogram ech·o·car·di·o·gram n. A visual record produced by echocardiography. Echocardiogram A non-invasive ultrasound test that shows an image of the inside of the heart. (TEE) showed the large thrombus in left atrial appendix with floating and erratically moving in left atrium (Fig. 1). It was moving freely from the upper part of left atrium to the lower part and protruding to left ventricle through the mitral valve (Fig. 2). There was no another abnormal finding by echocardiography. The diagnosis was lone atrial fibrillation lone atrial fibrillation Cardiology A Fib in a Pt < age 60, in absence an underlying pathology–eg, DM, CHD, HTN. See Atrial fibrillation. with large thrombus in the left atrium. There was a particular concern about embolisation given the highly mobile appearance of the thrombus. The patient denied the surgery. Treatment with continuous infusion of heparin (aPTT ratio>2.5) and coumadin (5mg/day) in addition to aspirin (100mg) and clopidogrel (75mg/day) were started. Bisoprolol (10mg/day) was also ordered to control the ventricular rate. When the INR INR In currencies, this is the abbreviation for the Indian Rupee. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. value was 2.5, heparin was stopped. Coumadin treatment adjusted to INR value to be 3-4. The patient was followed by echocardiography. It was determined that a loss of sensation in the left arm not to persist long. Follow-up TEE was carried out at the eleventh day of therapy. It was determined that left atrial thrombus was clearly resolved and it was only observed in left atrial appendix (Fig. 3). Therefore, the patient was discharged with coumadin, aspirin and clopidogrel. The INR value was checked to be 3-3.5 weekly. The TEE repeated two months later showed thrombus only in form of thin layer adjacent to the appendix wall (Fig. 4). [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] [FIGURE 3 OMITTED] [FIGURE 4 OMITTED] Kurtulus Ozdemir, Nazif Aygul, Ilknur Can, Alpay Aribas* Department of Cardiology, Meram Faculty of Medicine, Selcuk University, *Konya Numune Hospital, Cardiology, Konya, Turkey Address for Correspondence/Yazisma Adresi: Prof. Dr. Kurtulus Ozdemir Selcuk Universitesi Tip Fakultesi Kardiyoloji Anabilim Dali, Konya, Turkey Phone: +90 332 223 60 00/1847/1072 Fax: +90 332 223 61 81 E-mail: kurt33@hotmail.com |
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