Multiple cardioembolic attacks with a huge ventricular thrombus in dilated cardiomyopathy: A case report and comprehensive review

Abstract

Left ventricular thrombus is one of the major complications of dilated cardiomyopathy. Although the presence of a cardiac thrombus is a major risk factor for embolization, several probable conditions, the connection of which is not thoroughly studied, such as gout disease and methamphetamine abuse, are also possible causes. We present the case report of a male in his early 40s with a history of alcohol and methamphetamine abuse, gout, and dilated cardiomyopathy, experiencing multiple ischemic attacks, including acute limb ischemia, dysarthria, and renal infarct. Echocardiography revealed a large clot in the left ventricle. The patient received heparin at a rate of 1000 units/hour, followed by warfarin at 10 mg/day, and probenecid at 500 mg/day. The thrombus resolved upon anticoagulant therapy, with improvement in the patient’s symptoms. Left ventricular thrombus formation in dilated cardiomyopathy is influenced by many factors, including drug toxicity (for instance, methamphetamine), uric acid levels, and N-terminal precursor B-type natriuretic peptide. The thrombus can cause cardioembolic attacks in multiple sites, and the choice for emergent therapy is an oral anticoagulant, which may improve the ejection fraction. However, certain aspects related to cardiac thrombosis and embolization risk still warrant more comprehensive studies.