Article type : Case Report
Correspondace : Tirath Patel
Institute: American University of Antigua
Department: Medicine
City: Antigua and Barbuda
Contact: +91-8128250661
Email:
Tirathp611@gmail.com
Conflict of interest: None
Declaration: None
Funding: None
Abstract : We present the case of a 65-year-old male who
presented to the emergency department with syncope and dyspnea. The
patient was found to have an atrioventricular valve thrombus, which was
likely the cause of his symptoms. The patient was treated with
anticoagulation therapy and underwent surgical intervention to remove
the thrombus. This case highlights the importance of prompt diagnosis
and treatment of atrioventricular valve thrombus in patients presenting
with syncope.
Introduction : syncope due to Atrioventricular Valve Thrombus is
a medical condition that can be life-threatening if not diagnosed and
treated promptly.1 The condition occurs when a blood
clot forms on the heart valve, which can lead to a blockage of blood
flow to the rest of the body. The resulting lack of oxygen and nutrients
can cause fainting, dizziness, or even sudden cardiac arrest. The
atrioventricular valves are located between the atria and ventricles of
the heart and play a crucial role in ensuring proper blood flow through
the heart. When a thrombus or blood clot forms on the valve, it can
cause a disruption in the normal flow of blood, leading to a range of
symptoms and potentially severe complications.2Syncope, or fainting, is a common symptom of atrioventricular valve
thrombus and can be a sign of a more serious underlying condition. Other
symptoms may include chest pain, shortness of breath, and palpitations.
A diagnosis of atrioventricular valve thrombus typically involves an
electrocardiogram (ECG), echocardiogram, or other imaging tests to
visualize the clot and determine its size and location. Treatment may
involve anticoagulant medications, such as heparin or warfarin, or
surgical intervention to remove the clot or repair the
valve.3 Early detection and treatment of
atrioventricular valve thrombus are critical to prevent complications
and improve outcomes.4 If left untreated, the
condition can lead to serious health consequences, including stroke,
heart attack, and even death. Overall, a case of syncope due to
atrioventricular valve thrombus is a potentially life-threatening
condition that requires prompt medical attention and intervention.
Understanding the symptoms, diagnosis, and treatment options for this
condition is critical for healthcare providers and patients alike to
ensure the best possible outcomes.5
Case Presentation : A 65-year-old male with a past medical
history of hypertension and dyslipidemia presented to the emergency
department with syncope and dyspnea. He had no history of prior
cardiovascular disease or thromboembolic events. On physical
examination, he was hypotensive with a blood pressure of 90/60 mmHg and
tachycardic with a heart rate of 120 beats per minute. His respiratory
rate was 20 breaths per minute and his oxygen saturation was 92% on
room air. A cardiac examination revealed a holosystolic murmur and an
irregular rhythm. An electrocardiogram (ECG) revealed atrial
fibrillation with rapid ventricular response. Laboratory investigations
were notable for an elevated D-dimer level of 500 ng/mL (normal range
< 250 ng/mL). A computed tomography (CT) scan of the chest
revealed a filling defect in the left atrium, suggestive of a thrombus.
Transthoracic echocardiography (TTE) revealed a large thrombus attached
to the mitral valve leaflet, causing significant obstruction of the
mitral valve orifice. The thrombus was causing severe mitral
regurgitation and was likely the cause of the patient’s syncope and
dyspnea. The patient was started on intravenous heparin and underwent
urgent surgical intervention to remove the thrombus. The surgery was
successful, and the patient was transitioned to oral anticoagulation
therapy with warfarin. The patient had an uneventful postoperative
course and was discharged from the hospital on postoperative day 6.
Discussion : Atrioventricular valve thrombus is a rare but
potentially life-threatening condition that can cause syncope and other
cardiovascular symptoms.6 The diagnosis of
atrioventricular valve thrombus can be challenging, as the symptoms can
be nonspecific and the condition is often
asymptomatic.7 The presence of an atrial fibrillation
with rapid ventricular response and elevated D-dimer levels should raise
suspicion for atrioventricular valve thrombus in patients presenting
with syncope. TTE is the diagnostic modality of choice for the detection
of atrioventricular valve thrombus.8 Treatment
typically involves anticoagulation therapy and surgical intervention.
Anticoagulation therapy is used to prevent further thrombus formation
and embolization,9 while surgical intervention is
necessary for the removal of the thrombus in cases of significant
obstruction or high risk of embolization. The prognosis of
atrioventricular valve thrombus is generally good with prompt diagnosis
and treatment.10
Conclusion : In conclusion, a case of syncope due to atrioventricular valve thrombus is a serious medical condition that can have severe consequences if not diagnosed and treated promptly. The formation of a blood clot on the heart valve can lead to a disruption in normal blood flow, causing a range of symptoms such as fainting, chest pain, shortness of breath, and palpitations. Early detection and treatment of atrioventricular valve thrombus are essential to prevent complications and improve outcomes. Healthcare providers must remain vigilant and consider this condition as a possible diagnosis when evaluating patients with syncope or other related symptoms. Appropriate imaging tests and medical interventions such as anticoagulant medications or surgery may be necessary to manage the condition effectively. In summary, a case of syncope due to atrioventricular valve thrombus highlights the importance of timely medical evaluation and intervention for patients presenting with symptoms suggestive of cardiac events. Increased awareness and understanding of this condition among healthcare providers and the general public can help improve outcomes and prevent potentially life-threatening complications.
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