Arterial hypertension, dyslipidemia and symptomatic AF, manifestations of left atrial thrombus
Studies have shown that the presence of left atrial thrombus in patients with atrial fibrillation (AF) correlates with a high risk of stroke. Mitral stenosis is an acquired disease that causes atrial pressure overload. Similarly, significant anatomical and electrical remodelling of the left atrium. This leads to AF and atrial thrombus formation. However, with anticoagulation, the risk of stroke in AF patients decreases.
Studies have further shown that in patients with AF and MS not taking any anticoagulants, the incidence of left atrial thrombus is 25% to 55%. The study further states “the intracardiac thrombotic masses are localized in the left atrium and the left atrial appendage in 57% of cases”. Similarly, it is important to administer oral anticoagulants if AF complicates MS. In patients with moderate and severe MS it is recommended to use VKA and regularly measure INR.
Case study
In a similar case, a 65-year-old woman with arterial hypertension and dyslipidemia presented with symptomatic AF. Doctors referred the patient was electro cardioversion, a procedure to an abnormal heartbeat to a normal rhythm. Similarly, doctors also prescribed apixaban 5 mg, two times a day for stroke prevention. Echocardiography prior to the procedure showed moderate MS with calcifications including an accessory intra-atrial movable mass. Doctors further suspected distal embolisation because of high mobility of the intracardiac mass with moderate MS and persistent AF. The patient qualified for surgery and the cardioversion was postponed.
For treatment, doctors advised surgical thrombus removal with mitral valve replacement, without vitamin K antagonist treatment. The patient’s recovery was uneventful. He was also prescribed low-molecular-weight heparin and VKA for long-life treatment. The histopathological analysis further confirmed the diagnosis of left atrial thrombus with a small degree of calcification.
Source: American Journal of Case Reports
