The Discovery of an Intracardiac Thrombus Following a Mild COVID-19 Infection: A Case Report and Review of Literature

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) is a viral disease that predominantly affects the respiratory system, but extrapulmonary manifestations have been increasingly reported over the course of the pandemic. Common extrapulmonary manifestations include the gastrointestinal, cardiovascular, and neurological systems, such as diarrhea, rashes, loss of smell/taste, myalgia, acute kidney injury, cardiac arrhythmias, or heart failure. COVID-19 infection is associated with an increased risk of thromboembolic events, especially in the setting of severe disease. We present a case of a 42-year-old female who recently tested positive for COVID-19 infection and presented to the clinic with complaints of palpitations that started after her diagnosis. An electrocardiogram done in the clinic showed sinus rhythm, and the patient was placed on an event monitor, which showed no evidence of tachyarrhythmia. A transthoracic echocardiogram (TTE) done as part of the workup showed a large thrombus in the right ventricular outflow tract attached to the ventricular side of the pulmonic valve. The patient was started on a therapeutic dose of apixaban at 10 mg twice a day (BID) for seven days and 5 mg twice a day afterward.

Right Ventricle Thrombus and COVID-19 Infection: An Uncommon Report of Three Cases

“…3 In our case series, we suggest maintaining a low threshold for screening intracardiac thrombus using 2D-echo as demonstrated by Subramanyam et al, 4 Mitsis et al, 5 and Ramalho et al 6 These studies revealed instances of RVT and left ventricular thrombus as well as thrombus attachment to valves such as the pulmonary valve. 7,8 Considering that intracardiac thrombus is not an uncommon condition, routine screening using 2D-echo proves to be highly beneficial. Various modalities available for managing RVT include anticoagulation, surgical embolectomy, and systemic thrombolysis.…”