Thrombosis and Left Intraventricular Spontaneous Contrast Complicating Ischemic Cardiomyopathy Clinical case
Introduction: Thrombosis and spontaneous left ventricular contrast are complications of various cardiomyopathies, both ischemic and non-ischemic. Their recognition, prevention, and treatment remain important due to the potential risk of thromboembolic complications.
Observation: a 36-year-old male taxi driver, single, and father of five, was admitted to the ward on February 1, 2026, for congestive heart failure.
This patient, a smoker, had been hospitalized the previous year at the Military Hospital for a nonQ-wave myocardial infarction complicated by congestive heart failure. His discharge medication regimen included a low-sodium diet, furosemide, ramipril, nebivolol, atorvastatin, and acetylsalicylic acid. He had been non-adherent to his prescribed treatment. Dyspnea, which had occurred 10 days prior, was the reason for this hospitalization.
-The clinical examination revealed : tachycardia, a gallop rhythm, a blood pressure of 108/62 mmHg, painful hepatomegaly, and edema of the lower limbs.
Paraclinical examinations
-Echocardiography showed biventricular systolic dysfunction, a reduced left ventricular ejection fraction (26%), tetracavitary dilation, and a fixed thrombus at the apex of the left ventricle.
-In the blood tests, the BNP level was 1200 pg/ml.
-The treatment included: fluid and sodium restriction, enoxaparin followed by acenocoumarol, losartan, spironolactone, dapagliflozin, and rosuvastatin. On day 12, the following were noted: resolution of heart failure, persistence of the thrombus. Discharge was authorized, nebivolol was reintroduced, a direct oral anticoagulant (DOAC) was prescribed, and weekly follow-up was obtained. On day 57, the thrombus had disappeared, spontaneous contrast enhancement was observed, and the DOAC was continued. The patient was again lost to follow-up.
Conclusion: Echocardiography is fundamental in the diagnosis and monitoring of thrombosis and spontaneous intracardiac contrast. Patient education is essential in our setting.