The case of an octogenarian who died of acute myocardial infarction complicated with acute pulmonary embolism from a right ventricular thrombus

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  • Ochiai Tetsuya
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Higashitani Michiaki
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Ookoshi Satoko
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Kasamaki Ryota
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Taya Yuji
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Nemoto Yoshiko
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Komatsu Yasushi
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Abe Norihiro
    Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
  • Shiina Kazuki
    Department of Cardiology, Tokyo Medical University Hospital
  • Chikamori Taishiro
    Department of Cardiology, Tokyo Medical University Hospital

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Other Title
  • 急性心筋梗塞に右室血栓からの急性肺塞栓症を合併し死亡した超高齢者の1例
  • キュウセイ シンキン コウソク ニ ウシツ ケッセン カラ ノ キュウセイ ハイ ソクセンショウ オ ガッペイ シ シボウ シタ チョウコウレイシャ ノ 1レイ

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Abstract

<p>An 86-year-old female on dialysis experienced a decrease in blood pressure and worsening of her respiratory condition during dialysis, for which she visited our emergency unit. She was admitted to our Department of Cardiology with a diagnosis of acute myocardial infarction complicated with heart failure because of anterior wall of left ventricular dysfunction, positive troponin T levels and negative T wave on a precordial lead electrocardiogram. On the same day, she underwent coronary angiography and stenting at left anterior descending artery #7 with 99% stenosis. She also showed an elevated D-dimer level on admission, and contrast-enhanced computed tomography (CT) was performed the day after admission, considering the likelihood of respiratory failure due to pulmonary thromboembolism. However, the findings were negative. On the 4th day of hospitalization, she showed marked hypoxemia. Her D-dimer level was further elevated, and when she underwent enhanced CT again, there was no evidence of deep vein thrombosis, but thrombus in the pulmonary artery and apex of right ventricle was noted. She was therefore diagnosed with acute pulmonary embolism due to thrombosis from the right ventricle rather than from a deep vein. She rapidly received anticoagulant therapy and non-invasive positive pressure ventilation therapy for respiratory failure, but she entered cardiopulmonary arrest and quickly died. She was suspected to have been complicated with a right ventricular infarction and an acute anterior wall myocardial infarction, resulting in a large thrombus along the apex of the right ventricle. This case of both myocardial infarction and pulmonary embolism is very rare, and we report it here with consideration.</p>

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