Heart failure is a prevalent disease worldwide and while the diagnosis of heart failure has remained relatively unchanged via a careful history and physical examination, identification of the etiology of the heart failure and treatment has made significant advances. Mechanical circulatory support (MCS), neprilysin inhibitors, and chronic resynchronization therapy (CRT) are just some of the relatively recent therapies afforded to assist heart failure patients. Heart failure is a complicated, multifactorial diagnosis that requires a careful history and physical for diagnosis with the support of laboratory tests. While the prognosis for heart failure patients remains poor in comparison to other cardiovascular disease and even certain cancers, new advancements in therapy have shown survival and quality of life improvement.

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Left ventricular assist device (LVAD) implantation is an established treatment for patients with end-stage, systolic heart failure as a bridge to heart transplantation or destination therapy. LVAD pump thrombosis is a life-threatening complication than can be triggered by prothrombotic conditions such as infection. Management of pump thrombosis presents as both a diagnostic and therapeutic challenge that is associated with a high morbidity and mortality. We report a case of pump thrombosis in a patient with a HeartMate II (Abbott Laboratories, Chicago, IL) and coronavirus (COVID-19) infection that was treated successfully with an intravenous thrombolytic, tissue plasminogen activator.