• Indian heart journal · Jul 2013

    Case Reports

    Free floating right atrial thrombus with massive pulmonary embolism:near catastrophic course following thrombolytic therapy.

    • Ravindranath Khandenahally Shankarappa, Ravi S Math, Srinivas Papaiah, Yeriswamy M Channabasappa, Satish Karur, and Manjunath Cholenahally Nanjappa.
    • Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
    • Indian Heart J. 2013 Jul 1;65(4):460-3.

    AbstractA 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

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