ST-segment Elevation Myocardial Infarction with Left Ventricle Thrombus: Case Report

DOI

10.2991/978-94-6463-048-0_21How to use a DOI?

Keywords

Acute Myocard Infarct; Syntrom; Thrombus

Abstract

Acute myocardial infarction (AMI) occurs when there is evidence of myocardial injury (an increase in cardiac troponin values) and clinical evidence of myocardial ischemia. Data from the Jakarta Acute Coronary Syndrome Registry states that in 2014 there were 3015 patients with acute coronary syndrome (ACS); half of them were diagnosed with ST Elevation Myocardial Infarction (STEMI). Among patients with STEMI, 46% of cases did not receive reperfusion therapy. This case report aimed to describe the features, complications and management of ST segment elevation with left ventricular thrombus. A 44-year-old male patient came with complaints of chest pain that had been experienced for 8 h before entering hospital. The chest pain did not decrease with rest and radiated to the back of the chest. The patient is a heavy smoker and during electrocardiographic examination, ST elevation was found in leads V1-4. It was decided to perform primary percutaneous coronary intervention, but failed due to administrative matters. The patient, therefore, received Loading Aspilet 160 mg chewable, loading Ticagrelor 180 mg orally, Isosorbide dinitrate 5 mg Sublingual, repeated up to 3 times every 5 min, Glyceryl trinitrate 2 × 5 mg orally, Morphine 2 mg intravenously (after isosorbide dinitrate does not respond), Bisoprolol 1 × 2.5 mg orally, Atorvastatin 1 × 40 mg orally, Laxadyn syrup 3 × 10cc orally, Fibrinolytic with streptokinase 1.5 million units intravenous drip then followed by Injection enoxaparin 0.6 cc/12 h (for 5 days). After administering a streptokinase injection, a repeat electrocardiographic examination was performed and found a decrease in ST elevation in leads V1-4. Clinically, the chest pain began to decrease. The patient underwent echocardiography for the first time on 6 December, 2019 with Interpretation results: Segmental Wall motion abnormality at the apex, LV size: normal, LV muscle thickness: thickened, LV Function, normal diastolic function, normal systolic function, EF = 52%, VALVE, Mild mitral regurgitation. Further, a percutaneous coronary intervention was performed on December 11, 2019 The results are as follows: LAD: 70% eccentric proximal, LAD: 70% eccentric Middle, LCX: 50% eccentric proximal RCA: 60% concentric proximal, RCA: 50% proximal. After completing the coronary intervention, on 10 January 2019 patient was evaluated for echocardiography: segmental wall motion Abnormality at the EF apex 40%, Mild Mitral Regurgitation, Mild Tricuspid regurgitation, Mild Pulmonary Hypertension Thrombus at the apex size 1.69 cm × 3.5 cm. After finding a thrombus with echocardiographic evaluation, the patient was discharged with aspirin, clopidogrel, nitrate and atorvastatin. A few months later, echocardiography was repeated and the thrombus was no longer found at the apex of the left ventricle. This case report emphasizes the importance of optimal treatment of AMI cases with segment elevation to avoid heart failure and thrombus formation.

Copyright

© 2023 The Author(s)

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TY  - CONF
AU  - Doharjo Manullang
AU  - Hadi Wijaya
AU  - Imran Soleh
AU  - Erwin Sukandi
AU  - Taufik Indrajaya
PY  - 2022
DA  - 2022/12/19
TI  - ST-segment Elevation Myocardial Infarction with Left Ventricle Thrombus: Case Report
BT  - Proceedings of the 3rd International Conference on Cardiovascular Diseases (ICCvD 2021)
PB  - Atlantis Press
SP  - 183
EP  - 190
SN  - 2468-5739
UR  - https://doi.org/10.2991/978-94-6463-048-0_21
DO  - 10.2991/978-94-6463-048-0_21
ID  - Manullang2022
ER  -