title: [Spontaneous echo contrast in the left ventricle as an indicator for an increased risk of thromboembolism].
abstract: A 69-year-old man with coronary heart disease complained of pain in his right flank. He had dyspnoea, cough and fever up to 38.8 degrees C. In addition to various positive indicators of inflammatory disease he had a creatinine concentration of 1.8 mg/dl and an increased activity of lactate dehydrogenase (1655 U/l). The chest radiograph demonstrated pneumonia and computed tomography showed an infarct in the right kidney. The ECG indicated atrial fibrillation with an irregular ventricular rate and left bundle branch block. Echocardiography demonstrated dilatation of the left ventricle and a thrombus adherent to the wall. Transoesophageal echocardiography additionally recorded spontaneous type I echo-contrast, which disappeared after therapeutic heparinization. Cerebral infarctions were shown by computed tomography, undertaken because of neurological symptoms. There were also signs of silent myocardial ischaemia. As a coronary artery bypass operation was contraindicated, percutaneous transluminal balloon angioplasty was attempted but dissection occurred, causing irreversible cardiogenic shock of which the patient died.
authors.affiliation: Abteilung Kardiologie und Pulmonologie, Zentrum für Innere Medizin, Klinikum, Universität Göttingen.
authors.forename: R
authors.initials: R
authors.lastname: Schulz
authors.forename: C
authors.initials: C
authors.lastname: Bruch
authors.forename: B
authors.initials: B
authors.lastname: von Breska
authors.forename: W
authors.initials: W
authors.lastname: Sprecher
authors.forename: H
authors.initials: H
authors.lastname: Kreuzer
authors.forename: G S
authors.initials: GS
authors.lastname: Werner
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D013923:Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy
vernacular_title: Spontaner Echokontrast im linken Ventrikel als Indikator für ein erhöhtes Thromboembolie-Risiko.