scholarly journals Multiple Large Atrial Thrombus Due To Rheumatic Heart Disease And Present Of Atrial Fibrillation With No Sign Of Stroke: How Is It Possible?

2019 ◽  
Vol 3 (2) ◽  
pp. 191
Author(s):  
Ricky Indra Alfaray ◽  
Deisha Laksmitha Ayomi ◽  
Yan Efrata Sembiring
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Heart Valves ◽  
Brain Infarction ◽  
Major Complication ◽  
Atrial Thrombus ◽  
Rheumatic Heart

ABSTRACT  Atrial fibrillation is the most common arrhythmia associated with stroke and in the rheumatic heart disease patient’s atrial fibrillation can easily cause thromboembolism. Thromboembolism is the major complication also in patients of mitral stenosis with atrial fibrillation. A 54-year-old woman with uncontrollable movements in the right arm, stomach, right leg and painful swelling at right ankle joint was admitted to the emergency department. Transesophageal echocardiogram revealed rheumatic heart disease affecting two valves and thrombus in left atrial extending towards left atrial appendage. Heart rate was 120 beats per minute. ECG showed atrial fibrillation. A patient has undergone mitral and aortic valves replacement surgery and left atrial thrombus evacuation. Despite the involvement of two heart valves and the presence of large thrombus, the patient did not show any sign of brain infarction. This is a contradiction with a theory which implies that atrial fibrillation is the most common arrhythmia associated with stroke and in the rheumatic heart disease patient’s atrial fibrillation can easily cause thromboembolism and become stroke. This study evaluates many factors founded in the patient that make this anomaly may happen.Keywords                   : atrial fibrillation, rheumatic heart disease, thromboembolism strokeCorrespondence to      : [email protected] Atrial fibrilasi merupakan jenis aritmia yang berkaitan erat dengan stroke dan cenderung menyebabkan thromboembolism. Thromboembolism merupakan komplikasi mayor dari mitral stenosis dengan atrial fibrilasi. Seorang wanita berusia 54 tahun masuk ke unit gawat darurat dengan keluhan utama gerakan tak terkendali pada lengan kanan, perut, kaki kanan, serta bengkak yang menyakitkan di sendi pergelangan kaki kanan. Echocardiogram transesophageal menunjukan gambaran penyakit jantung rematik pada dua katup dan trombus di atrium kiri meluas menuju valve atrium kiri. Detak jantung 120 kali per menit. EKG menunjukkan fibrilasi atrium. Pasien menjalani operasi penggantian katup mitral dan aorta serta evakuasi trombus pada atrium. Meskipun terdapat abnormalitas pada dua katup jantung ditambah dengan ditemukan adanya trombus besar pada atrium, pasien tidak menunjukkan tanda-tanda infark otak. Ini bertentangan dengan teori yang mengimplikasikan bahwa atrial fibrilasi adalah aritmia paling umum yang berhubungan dengan stroke dan pada penyakit jantung reumatik. Pasien dengan fibrilasi atrium dapat dengan mudah terjadi tromboemboli hingga bermanifestasi stroke. Studi ini mengevaluasi berbagai faktor yang memungkinkan anomali kasus seperti ini dapat terjadi.Kata kunci                  : fibrilasi atrium, penyakit jantung rematik, stroke thromboemboliKorespondensi             : [email protected] 

scholarly journals Spectrum of left atrial thrombus in rheumatic heart disease

2014 ◽  
Vol 2014 (apr30 1) ◽  
pp. bcr2014204370-bcr2014204370
Author(s):  
H. Mahla ◽  
K. K. Harlalka ◽  
S. Bhairappa ◽  
C. N. Manjunath
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Left Atrial ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Rheumatic Heart

scholarly journals Clinical and Echocardiographic Profile of Rheumatic Heart Disease: A Cross-Sectional Study

2021 ◽  
pp. 1-7
Author(s):  
Abdul Qadir Khan Dall ◽  
Muhammed Kashif Shaikh ◽  
Syed Zulfiquar Ali Shah ◽  
Tarachand Devrajani ◽  
Abdul Salam Memon ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement ◽  
The Common ◽  
Echocardiographic Findings ◽  
Rheumatic Heart

Background: Rheumatic Heart disease (RHD) is the leading cause of acquired heart disease and more prevalent in developing countries. The objective of the study was to determine the clinical and echocardiographic profiles of patients with rheumatic heart disease (RHD). Materials and Methods: All patients above the age of 12 years of either gender diagnosed with Rheumatic heart disease from January 2018 to December 2019 at tertiary care hospital, Hyderabad were enrolled in the study. Detailed patient data was obtained from the hospital records. Information regarding gender, age, Electrocardiogram findings, clinical and echocardiographic manifestations was obtained. Results: Throughout the two-year study period, a total of fifty patients with RHD were studied. The mean age of the population was 33.71 years. Females (64%) outnumbered males and 60% were rural population. The clinical features observed were fever (80%), joint pain (64%), palpitation (60%), breathlessness (90%) and chest pain (50%), tachycardia (60%), raised JVP (10%), hypertension (20%). The common echocardiographic findings observed were mitral stenosis (50%), mitral regurgitation (24%) and pulmonary hypertension (36%), left atrial enlargement (56%), and right atrial enlargement (16%) whereas the majority of the patients (70%) have ejection fraction between 40-50% and thrombus was identified in 15 (30%) patients respectively. Conclusion: Common clinical findings observed were breathlessness and fever while the common echocardiographic findings were mitral stenosis and regurgitation, pulmonary hypertension, and left atrial enlargement. Population-based screening by echocardiography could be a potential route for early screening of rheumatic heart disease.

scholarly journals A Case of Massive Left Atrial Thrombus

2021 ◽  
Author(s):  
John Ahn ◽  
Colin Burke ◽  
Lindsay Howitt ◽  
Tim Glenie ◽  
Gary Lau
Keyword(s):  
Heart Disease ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Mitral Valve Stenosis ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Left Atrial Appendage Thrombus ◽  
Common Cause ◽  
Rheumatic Heart

Rheumatic heart disease is the most common cause of mitral valve stenosis. Left atrial appendage thrombus is associated with mitral stenosis, but in rare cases the thrombus can extend to the left atrial cavity. We present a case of a severe rheumatic mitral stenosis and associated large left atrial thrombus, with embolic sequelae.

scholarly journals Atrial fibrillation with flutter episode in patient with mitral stenosis

2018 ◽  
Vol 41 (3) ◽  
pp. 134
Author(s):  
Deri Arara ◽  
Yerizal Karani
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Thrombus Formation ◽  
The Other ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Common Etiology ◽  
Severe Degree ◽  
Rheumatic Heart

Mitral stenosis (MS) is a condition which happened because of congenital or acquired event. The most common etiology of MS in Indonesia is Rheumatic Heart Disease (RHD). Chronic inflammation on the mitral valve could lead to stenosis from mild to severe degree. Mitral stenosis could lead to many complications such as pulmonary hypertension and atrial fibrillation (AF). The prevalence of AF in patients with MS is related to the severity of valve obstruction and patient age. AF event in patient with MS could be happen because of Left Atrial (LA) dilatation of the patient. The mechanism that responsible for AF in patient with MS is a complex one. AF even with or without atrial flutter episode could lead a deterioration of patient hemodynamic. In the other way, the patient also predisposes to left atrial thrombus formation and systemic embolic events. Good awareness in diagnosis and management of atrial fibrillation in patient with MS are mandatory to reduce the morbidity and mortality.

Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease

2021 ◽  
Author(s):  
Alexander P Benz ◽  
Jeff S Healey ◽  
Ashley Chin ◽  
Patrick Commerford ◽  
Tamara Marsden ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Heart Disease ◽  
High Risk ◽  
Rheumatic Heart Disease ◽  
Mitral Stenosis ◽  
Independent Risk Factor ◽  
Stroke Risk ◽  
Significant Proportion ◽  
Rheumatic Heart

Abstract Aims Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), especially mitral stenosis, are assumed to be at high risk of stroke, irrespective of other factors. We aimed to re-evaluate stroke risk factors in a contemporary cohort of AF patients. Methods and Results We analyzed data of 15,400 AF patients presenting to an emergency department and who were enrolled in the global RE-LY AF registry, representing 47 countries from all inhabited continents. Follow-up occurred at 1 year after enrollment. A total of 1,788 (11.6%) patients had RHD. These patients were younger (51.4 ± 15.7 vs. 67.8 ± 13.6 years), more likely to be female (66.2% vs. 44.7%) and had a lower mean CHA2DS2-VASc score (2.1 ± 1.7 vs. 3.7 ± 2.2) as compared to patients without RHD (all p < 0.001). Significant mitral stenosis (average mean transmitral gradient 11.5 ± 6.5 mmHg) was the predominant valve lesion in those with RHD (59.6%). Patients with RHD had a higher baseline rate of anticoagulation use (60.4% vs. 45.2%, p < 0.001). Unadjusted stroke rates at 1 year were 2.8% and 4.1% for patients with and without RHD, respectively. The performance of the CHA2DS2-VASc score was modest in both groups (stroke at 1 year, c-statistics 0.69, 95% confidence interval [CI] 0.60-0.78 and 0.63, 95% CI 0.61-0.66, respectively). In the overall cohort, advanced age, female sex, prior stroke, tobacco use and non-use of anticoagulation were predictors for stroke (all p < 0.05). Mitral stenosis was not associated with stroke risk (adjusted odds ratio 1.07, 95% CI 0.67-1.72, p = 0.764). Conclusions The performance of the CHA2DS2-VASc score was modest in AF patients both with and without RHD. In this cohort, moderate-to-severe mitral stenosis was not an independent risk factor for stroke. Translational perspective Based on studies conducted several decades ago, the presence of moderate-to-severe mitral stenosis has been associated with a very high risk of stroke in patients with AF. Our results, based on a large, global sample of contemporary patients with AF that contained a significant proportion of individuals with RHD, challenge the assumption that mitral stenosis is a major, independent risk factor for stroke. The performance of the widely used CHA2DS2-VASc score was modest in both patients with and without RHD. At least one ongoing randomized trial is evaluating the optimal antithrombotic strategy in patients with AF and RHD.

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