[Heparin induced thrombocytopenia, left ventricular thrombus and cerebral embolism during an acute myocardial infarction].
METHODS
A 58-year-old male patient was admitted to the emergency room after reanimation in hypotensive shock, under sedation and respiration.


METHODS
The cardiac laboratory markers were within normal limits. The ECG demonstrated a sinustachycardia with typical infarction signs. The echocardiogram showed a hypokinesia of the cardiac apex. DIAGNOSTICS, TREATMENT AND COURSE: Acute myocardial infarction was treated with a systemic rt-PA lysis. The course was complicated by: confirmed heparin-induced thrombocytopenia, left ventricular thrombus and a cerebral embolism. After multiple adaptations of the anticoagulation regimen, the patient was discharged in a good condition without major neurologic deficits.


CONCLUSIONS
With a careful anticoagulation regimen it is possible to achieve a successful outcome in major complications such as heparin-induced thrombocytopenia, left ventricular thrombus and cerebral embolism.
Jakobs
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Medizinische Klinik I, Allgemeine Innere Medizin, Gastroenterologie, Diabetologie, Stoffwechsel und Ernährung, Evangelisches und Johanniter-Klinikum Duisburg/Dinslaken/Oberhausen. jakdaniels@t-online.de
D000925:Anticoagulants / Q000009:adverse effects*; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000209:etiology; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced*; D015912:Thrombolytic Therapy / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D000925:Anticoagulants; D006493:Heparin