title: Echocardiographic diagnosis, management and monitoring of pulmonary embolism with right heart thrombus in a patient with myotonic dystrophy: a case report.
abstract: Acute pulmonary embolism (PE) is a common disease which frequently results in life-threatening right ventricular (RV) failure. High-risk PE, presenting with hypotension, shock, RV dysfunction or right heart thrombus is associated with a high mortality, particularly during the first few hours. Accordingly, it is important to commence effective therapy as soon as possible. In the case described in this report, a 49-year-old woman with myotonic dystrophy type 1 presented with acute respiratory failure and hypotension. Transthoracic echocardiography showed signs of right heart failure and a mobile right heart mass highly suspicious of a thrombus. Based on echocardiographic findings, acute thrombolysis was performed resulting in hemodynamic stabilization of the patient and complete resolution of the right heart thrombus. This case underscores the important role of transthoracic echocardiography for the diagnosis, management and monitoring of PE and underlines the efficacy and safety of thrombolysis in the treatment of PE associated with right heart thrombus.
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Germany. bernd.hewing@charite.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Hewing
authors.forename: Leyli
authors.initials: L
authors.lastname: Ghaeni
authors.forename: Henryk
authors.initials: H
authors.lastname: Dreger
authors.forename: Eva M
authors.initials: EM
authors.lastname: Fallenberg
authors.forename: Alexander
authors.initials: A
authors.lastname: Panda
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
mesh_terms: D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009223:Myotonic Dystrophy / Q000150:complications*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy
references.citation: Am J Cardiol. 1996 Aug 15;78(4):469-73
references.pmid: 8752195
references.citation: Circulation. 1999 Mar 16;99(10):1325-30
references.pmid: 10077516
references.citation: Eur Heart J. 1989 Dec;10(12):1046-59
references.pmid: 2606115
references.citation: Heart. 1997 Nov;78(5):515-6
references.pmid: 9415016
references.citation: Cardiology. 2000;94(1):1-11
references.pmid: 11111138
references.citation: Rinsho Shinkeigaku. 1997 May;37(5):374-8
references.pmid: 9294322
references.citation: Chest. 2005 Mar;127(3):1051-3
references.pmid: 15764793
references.citation: Semin Neurol. 1999;19(1):25-33
references.pmid: 10711986
references.citation: Eur Heart J. 2008 Sep;29(18):2276-315
references.pmid: 18757870
references.citation: Int J Cardiol. 2005 Mar 30;99(3):381-8
references.pmid: 15771917
references.citation: Chest. 2002 Mar;121(3):806-14
references.pmid: 11888964
references.citation: Curr Opin Neurol. 2007 Oct;20(5):572-6
references.pmid: 17885447
references.citation: J Am Coll Cardiol. 2003 Jun 18;41(12):2245-51
references.pmid: 12821255
references.citation: Eur J Echocardiogr. 2007 Jun;8(3):229-31
references.pmid: 16716753
references.citation: Am J Cardiol. 1997 May 15;79(10):1433-5
references.pmid: 9165180