Intracardiac thrombi in antiphospholipid syndrome (APS)
APS is a multisystem autoimmune disease associated with recurrent arterial and venous thrombosis and pregnancy loss. Cardiac manifestations include valve abnormalities, coronary artery disease, myocardial dysfunction, pulmonary hypertension and intracardiac thrombi. A potentially life-threatin...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/39051 |
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I10-R327-article-39051 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
intracardiac thrombi antiphospholipid syndrome Trombos intracardíacos síndrome antifosfolípido |
| spellingShingle |
intracardiac thrombi antiphospholipid syndrome Trombos intracardíacos síndrome antifosfolípido Tissera, Y Figueroa, R Alonso, CG Gobbi , C Maldini , C Savio, V Alviero, J Alba, P Intracardiac thrombi in antiphospholipid syndrome (APS) |
| topic_facet |
intracardiac thrombi antiphospholipid syndrome Trombos intracardíacos síndrome antifosfolípido |
| author |
Tissera, Y Figueroa, R Alonso, CG Gobbi , C Maldini , C Savio, V Alviero, J Alba, P |
| author_facet |
Tissera, Y Figueroa, R Alonso, CG Gobbi , C Maldini , C Savio, V Alviero, J Alba, P |
| author_sort |
Tissera, Y |
| title |
Intracardiac thrombi in antiphospholipid syndrome (APS) |
| title_short |
Intracardiac thrombi in antiphospholipid syndrome (APS) |
| title_full |
Intracardiac thrombi in antiphospholipid syndrome (APS) |
| title_fullStr |
Intracardiac thrombi in antiphospholipid syndrome (APS) |
| title_full_unstemmed |
Intracardiac thrombi in antiphospholipid syndrome (APS) |
| title_sort |
intracardiac thrombi in antiphospholipid syndrome (aps) |
| description |
APS is a multisystem autoimmune disease associated with recurrent arterial and venous thrombosis and pregnancy loss. Cardiac manifestations include valve abnormalities, coronary artery disease, myocardial dysfunction, pulmonary hypertension and intracardiac thrombi. A potentially life-threating but treatable manifestation of APS is intracardiac thrombus (IT). Thrombus formation can cause embolic pulmonary and systemic events and it remains uncertain about the mechanism of its formation. IT can occur in all cardiac chambers and needs to be differentiated from intracardiac myxoma. Echocardiography and cardiac MRI are the best tools for IT diagnosis. We present 2 cases of IT in APS.
CASE 1: A 39 years old woman who had a medical history of systemic lupus erythematosus diagnosed 3 years previously, she developed severe headache with right hemiparesis that fully recovered in 4 hours. Brain MRI showed left frontal diffusion restriction focus and carotid ultrasound without atherosclerotic lesions. Doppler Transthoracic echocardiography showed a mobile mass 22x 10 mm attached to the left atrial wall. (Image 1) Cardiac MRI showed 2 intracardiac thrombi attached by pedicle to posterior free wall of atrium (Image 2). A laboratory investigation revealed; Lupus anticoagulant (LA) positive, Anticardiolipin Ig G (ACL Ig G), Ig M (ACL Ig M) (-), Anti BGPI Ig G e IG M (-). She started on enoxaparin (therapeutic dose) and warfarin with a target 2.5-3. She stayed for 5 days in the hospital with improvement of her symptoms and repeated ECHO showed fully resolution of IT 6 months later.
CASE 2: A 36 years old man was referred for cardiac and rheumatology evaluation to our hospital. He had a medical history of primary APS diagnosed 8 years ago. He had 3 episodes of DVT and pulmonary emboli (PE)with triple positivity of antiphospholipid antibodies (LA, ACL Ig G and Anti-B2GPI Ig G) without treatment. He also had a history of overweight, smoking and cocaine consumption in the past. Four months before, he developed acute dyspnea and he was diagnosed of PE and he received thrombolytic therapy and he was discharged with oral anticoagulation. Two months later, he developed severe chest pain while he was at rest. ECG showed negative T wave from V1 to V3, and his cardiac enzymes were within normal limits. He received nitrates, statins. Low molecular heparin, aspirin and statins. He was discharge with oral anticoagulation with warfarin plus aspirin with INR of 3. Transthoracic echocardiography showed left ventricular dilatation with regional wall motion abnormalities and intracardiac thrombi of 33x22x39mm that it also was seen in cardiac MRI. (Image 3) Warfarin and aspirin treatment was prescribed.
IT has rarely been reported in APS patients. This cardiac manifestation should be considered because early diagnosis and proper management with anticoagulant therapy are essential to prevent mortality.
Keywords:
Intracardiac thrombi; antiphospholipid syndrome
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| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
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2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/39051 |
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2024-09-03T21:04:04Z |
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I10-R327-article-390512024-04-15T16:14:45Z Intracardiac thrombi in antiphospholipid syndrome (APS) Trombos intracardíacos en Síndrome antifosfolípido Tissera, Y Figueroa, R Alonso, CG Gobbi , C Maldini , C Savio, V Alviero, J Alba, P intracardiac thrombi antiphospholipid syndrome Trombos intracardíacos síndrome antifosfolípido APS is a multisystem autoimmune disease associated with recurrent arterial and venous thrombosis and pregnancy loss. Cardiac manifestations include valve abnormalities, coronary artery disease, myocardial dysfunction, pulmonary hypertension and intracardiac thrombi. A potentially life-threating but treatable manifestation of APS is intracardiac thrombus (IT). Thrombus formation can cause embolic pulmonary and systemic events and it remains uncertain about the mechanism of its formation. IT can occur in all cardiac chambers and needs to be differentiated from intracardiac myxoma. Echocardiography and cardiac MRI are the best tools for IT diagnosis. We present 2 cases of IT in APS. CASE 1: A 39 years old woman who had a medical history of systemic lupus erythematosus diagnosed 3 years previously, she developed severe headache with right hemiparesis that fully recovered in 4 hours. Brain MRI showed left frontal diffusion restriction focus and carotid ultrasound without atherosclerotic lesions. Doppler Transthoracic echocardiography showed a mobile mass 22x 10 mm attached to the left atrial wall. (Image 1) Cardiac MRI showed 2 intracardiac thrombi attached by pedicle to posterior free wall of atrium (Image 2). A laboratory investigation revealed; Lupus anticoagulant (LA) positive, Anticardiolipin Ig G (ACL Ig G), Ig M (ACL Ig M) (-), Anti BGPI Ig G e IG M (-). She started on enoxaparin (therapeutic dose) and warfarin with a target 2.5-3. She stayed for 5 days in the hospital with improvement of her symptoms and repeated ECHO showed fully resolution of IT 6 months later. CASE 2: A 36 years old man was referred for cardiac and rheumatology evaluation to our hospital. He had a medical history of primary APS diagnosed 8 years ago. He had 3 episodes of DVT and pulmonary emboli (PE)with triple positivity of antiphospholipid antibodies (LA, ACL Ig G and Anti-B2GPI Ig G) without treatment. He also had a history of overweight, smoking and cocaine consumption in the past. Four months before, he developed acute dyspnea and he was diagnosed of PE and he received thrombolytic therapy and he was discharged with oral anticoagulation. Two months later, he developed severe chest pain while he was at rest. ECG showed negative T wave from V1 to V3, and his cardiac enzymes were within normal limits. He received nitrates, statins. Low molecular heparin, aspirin and statins. He was discharge with oral anticoagulation with warfarin plus aspirin with INR of 3. Transthoracic echocardiography showed left ventricular dilatation with regional wall motion abnormalities and intracardiac thrombi of 33x22x39mm that it also was seen in cardiac MRI. (Image 3) Warfarin and aspirin treatment was prescribed. IT has rarely been reported in APS patients. This cardiac manifestation should be considered because early diagnosis and proper management with anticoagulant therapy are essential to prevent mortality. Keywords: Intracardiac thrombi; antiphospholipid syndrome El síndrome antifosfolípido (SAF) està asociado con trombosis arteriales, venosas y pérdidas fetales. Las manifestaciones cardíacas incluyen anormalidades valvulares, enfermedad arterial coronoaria, disfunción miocárdica, hipertensión pulmonar y trombos intracardíacos (TIC). Los cuales pueden producirse en cualquier cavidad cardíaca y deben diferenciarse del mixoma. Presentamos dos casos de TIC. CASO 1: Mujer, 39 años, con antecedentes de lupus eritematoso sistémico de 3 años de evolución en remisión, presenta cefalea pulsátil, frontal, intensa asociada a hemiparesia braquial derecha que remite a las 4 horas. RNM cerebral: foco de restricción de la difusión en frontal inferior izquierdo. Eco doppler carotídeo: normal, se realiza ecocardiograma doppler: imagen móvil de 22 x 10 mm homogénea, de bordes regulares adheridas a pared libre de aurícula izquierda. Cardiorresonancia: 2 imágenes de trombos frescos, friables, en la luz de la cavidad unidos por pedículo a pared libre posterior de aurícula. Serología autoinmune: Anticoagulante lúpico (AL) (+), Anticardiolipinas Ig G, Ig M (-), Anti B2GPI Ig G y M (-). Se interna en unidad de cuidados intensivos, se inicia anticoagulación con resolución de trombos a los 6 meses. CASO 2: Hombre, 36 años con antecedentes de SAF trombótico de 8 años de evolución, 3 episodios de trombosis venosa profunda y tromboembolismo pulmonar (TEPA) al diagnóstico. Enolista, falta de adherencia al tratamiento, ex tabaquista, ex cocainómano y sobrepeso. Ingresa por disnea asociada a dolor torácico, con diagnóstico de TEPA lobar derecho inferior con compromiso hemodinámico, requiriendo terapia trombolítica, asistencia respiratoria mecánica e internación en unidad de cuidados intensivos. Es dado de alta con anticoagulación. A los 2 meses consulta por dolor precordial y disnea, ingresa con diagnóstico de TEPA y sospecha de cardiopatía isquémica. Laboratorio: RIN 3.01, Anticardiolipinas Ig G (+), Ig M) (-), Anti B2GPI Ig G (+) e IG M (-). Ecocardiograma doppler y cardiorresonancia; dilatación de VI, trastornos segmentarios de la motilidad, imagen de un trombo pediculado móvil de 33x22x39 mm con riesgo embolígeno. Cinecoronariografía: disección de la arteria descendente anterior. Tratamiento anticoagulación y AAS. Los TIC han sido raramente reportados en SAF. Esta manifestación cardíaca debe ser considerada porque su diagnóstico temprano y el manejo adecuado son esenciales para prevenir la mortalidad. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-10-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion . https://revistas.unc.edu.ar/index.php/med/article/view/39051 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. Suplemento JIC XXIII (2022): Suplemento JIC XXIII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |