Image in Cardiology
High-risk pulmonary embolism with right heart thrombi
Tromboembolia pulmonar de risco elevado com trombos na cavidade auricular direita
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Providência" "autores" => array:5 [ 0 => array:4 [ "nombre" => "F.átima" "apellidos" => "Saraiva" "email" => array:1 [ 0 => "saraiva.fatima@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Fonseca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Rui" "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Lino" "apellidos" => "Gonçalves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Luís Augusto" "apellidos" => "Providência" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Medicina, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tromboembolia pulmonar de risco elevado com trombos na cavidade auricular direita" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1 and 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 2497 "Ancho" => 1583 "Tamanyo" => 343708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple thrombi inside the right atrium.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of an 82-year-old female patient, institutionalized, obese, hypertensive, and with left hemiparesis due to recent stroke (less than a month previously), who was referred for breathing difficulties and hemodynamic instability. On physical examination, she was conscious but confused and uncooperative, cyanotic, tachypneic (38<span class="elsevierStyleHsp" style=""></span>cpm), subfebrile (37.3<span class="elsevierStyleHsp" style=""></span>°C), hypotensive (84/34<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg) and tachycardic (120–130<span class="elsevierStyleHsp" style=""></span>bpm). Auscultation revealed diffuse wheezing and rhonchi and a grade II systolic murmur, more audible over the left sternal border. The patient also had moderate edema of both ankles.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Blood gas analysis detected severe respiratory alkalosis. The ECG showed sinus rhythm, with left and right bundle branch block. Relevant laboratory results included elevated troponin I, D-dimers and BNP. Echocardiography revealed severe right chamber dilatation, depressed right ventricular systolic function (tricuspid annular plane systolic excursion: 11<span class="elsevierStyleHsp" style=""></span>mm) and multiple cylindrical formations inside the right atrium, suggestive of thrombi (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1 and 2</a>). There was mild tricuspid regurgitation and pulmonary artery systolic pressure was 45<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg. In the light of these findings, further diagnostic exams were considered unnecessary and a diagnosis of high-risk pulmonary thromboembolism (PTE) was assumed. Anticoagulation with heparin was immediately begun, together with inotropic support with dopamine. In view of the patient's limited functional status and recent ischemic stroke, it was decided not to perform fibrinolysis or embolectomy and she died two days later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Detection of right heart thrombi on transthoracic echocardiography in the context of PTE is uncommon (4–18%),<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> although it is more frequent in high-risk PTE and is a marker of poor prognosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> In such cases, fibrinolysis and/or embolectomy should be performed as early as possible, followed by effective anticoagulation with heparin; anticoagulation alone is not effective. Without treatment mortality is 80–100%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-08-18" "fechaAceptado" => "2011-09-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Saraiva, F; Tromboembolia pulmonar de risco elevado com trombos na cavidade auricular direita. Rev Port Cardiol 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2011.09.024">doi:10.1016/j.repc.2011.09.024</span></p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1 and 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 2497 "Ancho" => 1583 "Tamanyo" => 343708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple thrombi inside the right atrium.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Casazza" 1 => "A. Bongarzoni" 2 => "F. Centonze" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1997" "volumen" => "79" "paginaInicial" => "1433" "paginaFinal" => "1435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9165180" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mobile thrombi of the right heart in pulmonary embolism: delayed disappearance after thrombolytic treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Ferrari" 1 => "M. Benhamou" 2 => "F. Berthier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.127.3.1051" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "127" "paginaInicial" => "1051" "paginaFinal" => "1053" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15764793" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of right heart thromboemboli" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.S. Rose" 1 => "N.M. Punjabi" 2 => "D.B. Pearse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "806" "paginaFinal" => "814" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11888964" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Chartier" 1 => "J. Bera" 2 => "M. Delomez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1999" "volumen" => "99" "paginaInicial" => "2779" "paginaFinal" => "2783" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10351972" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of treatment of patients with echocardiographically detected right-sided heart thrombi: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.L. Kinney" 1 => "R.J. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "1989" "volumen" => "118" "paginaInicial" => "569" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2773775" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003100000005/v1_201305151729/S217420491200044X/v1_201305151729/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003100000005/v1_201305151729/S217420491200044X/v1_201305151729/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491200044X?idApp=UINPBA00004E" ]
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| 2023 January | 26 | 12 | 38 |
| 2022 December | 45 | 23 | 68 |
| 2022 November | 33 | 35 | 68 |
| 2022 October | 32 | 22 | 54 |
| 2022 September | 25 | 49 | 74 |
| 2022 August | 25 | 41 | 66 |
| 2022 July | 29 | 42 | 71 |
| 2022 June | 19 | 32 | 51 |
| 2022 May | 21 | 34 | 55 |
| 2022 April | 34 | 28 | 62 |
| 2022 March | 27 | 41 | 68 |
| 2022 February | 29 | 44 | 73 |
| 2022 January | 27 | 24 | 51 |
| 2021 December | 21 | 36 | 57 |
| 2021 November | 31 | 28 | 59 |
| 2021 October | 32 | 43 | 75 |
| 2021 September | 30 | 26 | 56 |
| 2021 August | 35 | 31 | 66 |
| 2021 July | 16 | 22 | 38 |
| 2021 June | 21 | 26 | 47 |
| 2021 May | 36 | 37 | 73 |
| 2021 April | 32 | 13 | 45 |
| 2021 March | 44 | 17 | 61 |
| 2021 February | 59 | 18 | 77 |
| 2021 January | 27 | 10 | 37 |
| 2020 December | 30 | 10 | 40 |
| 2020 November | 32 | 13 | 45 |
| 2020 October | 12 | 18 | 30 |
| 2020 September | 47 | 13 | 60 |
| 2020 August | 11 | 7 | 18 |
| 2020 July | 39 | 9 | 48 |
| 2020 June | 45 | 8 | 53 |
| 2020 May | 45 | 5 | 50 |
| 2020 April | 42 | 8 | 50 |
| 2020 March | 48 | 9 | 57 |
| 2020 February | 60 | 30 | 90 |
| 2020 January | 47 | 4 | 51 |
| 2019 December | 35 | 9 | 44 |
| 2019 November | 41 | 5 | 46 |
| 2019 October | 43 | 4 | 47 |
| 2019 September | 22 | 5 | 27 |
| 2019 August | 20 | 4 | 24 |
| 2019 July | 51 | 7 | 58 |
| 2019 June | 24 | 9 | 33 |
| 2019 May | 36 | 11 | 47 |
| 2019 April | 9 | 11 | 20 |
| 2019 March | 97 | 9 | 106 |
| 2019 February | 107 | 10 | 117 |
| 2019 January | 69 | 7 | 76 |
| 2018 December | 89 | 10 | 99 |
| 2018 November | 101 | 14 | 115 |
| 2018 October | 102 | 17 | 119 |
| 2018 September | 53 | 12 | 65 |
| 2018 August | 33 | 8 | 41 |
| 2018 July | 38 | 5 | 43 |
| 2018 June | 55 | 8 | 63 |
| 2018 May | 74 | 10 | 84 |
| 2018 April | 67 | 4 | 71 |
| 2018 March | 85 | 7 | 92 |
| 2018 February | 53 | 2 | 55 |
| 2018 January | 77 | 5 | 82 |
| 2017 December | 122 | 4 | 126 |
| 2017 November | 57 | 13 | 70 |
| 2017 October | 40 | 8 | 48 |
| 2017 September | 38 | 12 | 50 |
| 2017 August | 43 | 20 | 63 |
| 2017 July | 35 | 9 | 44 |
| 2017 June | 42 | 13 | 55 |
| 2017 May | 31 | 6 | 37 |
| 2017 April | 28 | 3 | 31 |
| 2017 March | 27 | 13 | 40 |
| 2017 February | 31 | 12 | 43 |
| 2017 January | 20 | 1 | 21 |
| 2016 December | 38 | 7 | 45 |
| 2016 November | 23 | 3 | 26 |
| 2016 October | 20 | 11 | 31 |
| 2016 September | 22 | 1 | 23 |
| 2016 August | 6 | 1 | 7 |
| 2016 July | 11 | 2 | 13 |
| 2016 June | 13 | 3 | 16 |
| 2016 May | 14 | 5 | 19 |
| 2016 April | 25 | 4 | 29 |
| 2016 March | 45 | 17 | 62 |
| 2016 February | 58 | 22 | 80 |
| 2016 January | 46 | 21 | 67 |
| 2015 December | 44 | 9 | 53 |
| 2015 November | 27 | 9 | 36 |
| 2015 October | 42 | 10 | 52 |
| 2015 September | 32 | 8 | 40 |
| 2015 August | 28 | 13 | 41 |
| 2015 July | 20 | 2 | 22 |
| 2015 June | 19 | 8 | 27 |
| 2015 May | 28 | 5 | 33 |
| 2015 April | 36 | 9 | 45 |
| 2015 March | 28 | 4 | 32 |
| 2015 February | 28 | 9 | 37 |
| 2015 January | 26 | 9 | 35 |
| 2014 December | 42 | 9 | 51 |
| 2014 November | 35 | 7 | 42 |
| 2014 October | 28 | 9 | 37 |
| 2014 September | 27 | 11 | 38 |
| 2014 August | 26 | 11 | 37 |
| 2014 July | 38 | 7 | 45 |
| 2014 June | 32 | 4 | 36 |
| 2014 May | 39 | 17 | 56 |
| 2014 April | 38 | 6 | 44 |
| 2014 March | 50 | 12 | 62 |
| 2014 February | 55 | 11 | 66 |
| 2014 January | 61 | 16 | 77 |
| 2013 December | 48 | 16 | 64 |
| 2013 November | 47 | 19 | 66 |
| 2013 October | 36 | 18 | 54 |
| 2013 September | 48 | 16 | 64 |
| 2013 August | 64 | 24 | 88 |
| 2013 July | 70 | 17 | 87 |
| 2013 June | 48 | 12 | 60 |
| 2013 May | 52 | 17 | 69 |
| 2013 April | 81 | 28 | 109 |
| 2013 March | 81 | 28 | 109 |
| 2013 February | 114 | 22 | 136 |
| 2013 January | 140 | 22 | 162 |
| 2012 December | 117 | 21 | 138 |
| 2012 November | 121 | 28 | 149 |
| 2012 October | 37 | 13 | 50 |
| 2012 September | 18 | 7 | 25 |
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