Multiple embolisations in rheumatic heart disease: a case report.
BACKGROUND
Though systemic thromboembolism is not an infrequent complication of rheumatic valvular disease, multiple embolic phenomena are rare.


OBJECTIVE
To present a patient with rheumatic heart disease associated with multiple embolic complications.


METHODS
A 44-year-old lady with rheumatic valvular disease and atrial fibrillation defaulted anticoagulant medication, and subsequently presented with acute chest pain, acute left ventricular failure, focal neurological deficit and gangrenous lower limb extremities. Electrocardiography showed atrial fibrillation and an old anteroseptal myocardial infarction. Echocardiography showed multiple valvular lesions and multiple thrombi in the left atrium. Computed tomogram scan demonstrated a large infarct involving the region supplied by the right middle cerebral artery. Bilateral above knee amputation was performed. Recovery from neurological deficit was complete. She had, during a 4-year follow-up and anticoagulation remained free of new clinically evident embolic complications. Serial echocardiography however showed that the atrial clots had persisted and presumably fibrosed.


CONCLUSIONS
Multiple systemic thromboembolisms are serious complication of atrial fibrillation of valvular aetiology, and their prevention requires continuous anticoagulation.
Isezuo
S A
SA
Department of Medicine Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. simeonisezuo@yahoo.com
Musa
A A
AA
Saidu
S A
SA
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D004077:Digoxin / Q000627:therapeutic use; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004077:Digoxin; D006493:Heparin; D001241:Aspirin